Abbison28:
Please complete the Health Questionnaire as best you can. We need your answers to troubleshoot these feeding issues.
General Information
Species of lizard:
Gecko's name:
Morph:
Gender:
Age:
Weight:
Total length:
Length of your reptile when you first acquired it:
Source (pet store, breeder, previous owner):
Captive bred or wild caught:
Vivarium
Enclosure dimensions (length x width x heighth):
Cage (type, size):
Substrate provided:
Types of hiding places provided:
Is there a humidity hide? location?
Please describe any other furnishings:
List recent changes in the environment, if any:
Lighting
Artificial lighting
Incandescent (“screw-in” bulbs): wattage(s):
Fluorescent (tube bulbs):
Natural lighting
Access to ambient daylight from a distant window:
Heating
Do you have a thermometer(s) in the cage?
What type and brand of thermometer (digital with probe, temperature gun, LCD strip, analog (circle), combo digital thermometer/hygrometer, stainless steel aquarium type, other):
What is the ground temperature right on the substrate under the warm dry hide:
What is the air temperature on the warm end about 4 inches up from the ground:
What is the air temperature on the cool end about 4 inches up from the ground:
What device(s) are used to heat the tank (Under Tank Heater, heat light, ceramic heat emitter, Flexwatt heat tape, hot rock, other):
Ventilation space for your UTH by elevating the tank above the shelf (some UTHs come with sticky feet for the tank corners):
Are you using a thermostat(s)?
Which hide does she/he spend most of her time?
Is the temperature decreased at night? by how much?
Humidity
Is the humidity measured?
Humidity range:
Diet
Insects and worms, list type:
Regular diet fed to the insects and worms:
Are the insects and worms formally “gutloaded” 1-2 days prior to feeding off to your gecko? If so with?
How often do you feed your gecko?
Please list any supplements (with brand names) used. How are they given and how often?
What calcium brand are you using? with D3, without or both?
Is the calcium in the tank with D3 or without?
Multivitamins (include brand name)?
Please list any recent additions/changes in the diet:
General Health
If your gecko is sick, please describe the signs and how long your gecko has been showing these signs:
Is your gecko’s general activity level normal, decreased, or increased?
Is your gecko’s appetite normal, decreased, or increased?
Have you noticed any of the following?
Weight (loss or gain):
Regurgitation:
Discharge from the eyes or nose:
Increased breathing rate or effort:
Change in the droppings:
Urates
---white or yellowish:
---size of urates as compared to size of feces:
Abnormal skin color or shedding:
Parasites on the skin or in the feces:
Weakness:
Previous problems and/or illnesses:
Other Critters in Same Cage or in Household
List other animals that are kept in the same cage:
Recent acquisitions (new pets within the past 6 months):
Are any of your other pets ill?
