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General Exotic Intake Form
Please fill out the form below before your appointment. Thank you.

Name*




First




Last


Pet's Name*
Email*


Phone*
Date Of Appointment*
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Day12345678910111213141516171819202122232425262728293031
Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
How long have you owned your pet?*
Where did you acquire your pet?*
Pet Store
Breeder
Adoption
Other
How often is your pet handled?*
Daily
Occasionally
Never
What type of habitat/enclosure does your pet have?*
What is the size of your pet's habitat/enclosure?*
Where is the habitat/enclosure located?*
Is your pet allowed to roam free in the house?*
Yes
No
Do you use any cage substrate (bedding)?*
Yes
No
If so, what kind?
If your pet is a mammal, do they use a litter box?
Yes
No
What type of furnishings are in your pet's habitat/enclosure? (Hides, Toys, Beds, Stones, Bowls, ect)*
How often is your pet's habitat/enclosure cleaned?*
What type of disinfectant is used?*
What is your pet's main diet?*
How often do you feed your pet and how much?
What other sources of food does your pet eat? (treats, fruits, vegetables, ect.)
How much and how often are these other food sources given?
Do you give your pet any supplements?*
Yes
No
If so, what kind of supplements?
What is your pets water source? (bowl, bottle, ect.)*
How often is your pet's water changed?*
Are there any other pets in your household?*
If so, do they interact?
Yes
No
What is the reason for your visit today?*
Does your pet have any previous medical problems?*
Do you need to make any changes to your chart? Home Address, Secondary Phone #, alternative contact, etc?


 












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Where to Find Us

1 Gibralter Way

Greensburg, PA, 15601
 
Call: (724) 216-5174

Email: info@kvetac.com
Mon-Thurs: 8:00 am-6:00 pm

Friday: 8:00 am-6:00 pm

Saturday*: 9:00 am-12:00 pm

Sunday: Closed
 
*Medication pick-ups and specimen drop-offs only. No vet available on Saturday.

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