Owner Information
Client Name
Patient Information
Sex
Is your pet spayed (female) or neutered (male)?
Hand Raised
Environment
Cage
Enclosure Humidity (if applicable)
Enclosure Temperature (if applicable)
What is the temperature gradient of the enclosure?
Bathing Habits
Type of Light (check those that apply)
Exposure to Light
Are you aware of any exposure your pet may have had to the following (Please check all that may apply)?
Enrichment (Please check all that apply and elaborate on following lines):
Diet
Access to Fresh Water
Exercise
Medical History
For the Visit Today
Other Pets in the Household
I acknowledge that completing this form does NOT schedule an appointment. I understand that I need to call Heartland Veterinary Hospital to book an appointment.
You will need to fill out a New Patient Form, we need this information for your Exotic pet. Thank you. 
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