Gender:?
Age:?
Weight:?
How big was the reptile when you first acquired it?bout 4 inches
Source (pet store, breeder, previous owner)

et store
Captive bred or wild caught?
Do you handle him? If so how often?
Enclosure:
Cage: type, size:86cm long viv
Substrate provided?repticarpet
What types of hiding places are provided?cool hide warm hide moist hide
Is there a humidity hide? location?middle
Please describe any other furnishings:
Lighting:
Artificial lighting?no
incandescent (“screw-in” bulbs): wattage(s) ?
fluorescent (tube bulbs)?
Temperature:
Do you have a thermometer(s) in the cage? what type?digital probe
What is the temperature in the warm part of the cage? under the warm hide? In the coolest part?warm side between 90 and 95 cool between 75 and 80
What device(s) are used to maintain the temperature? hot rock, UTH, heat light, ceramic heater, other:uth covers third of tank
Are you using a thermostat?yes
Which hide does she/he spend most of her time?warm and moist
Is the temperature decreased at night? by how much?
Humidity:
Is the humidity measured? Range:
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?
List recent changes in the environment, if any:
Diet:
Insects, list type?locusts and dubia
Are they “gut loaded”? If so with?insect gut load
How often do you feed your reptile?daily
Please list any supplements 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?pure calcium in tank dust with reptivite with d3 2x week
Please list any recent additions/changes in the diet:
If your reptile is sick, please describe the signs and how long your reptile has been showing these signs:
Is your reptile’s general activity level normal, decreased, or increased?
Is your reptile’s appetite normal, decreased, or increased?
Have you noticed any of the following?
Weight loss, Weight gain
Discharge from the eyes or nose
Increased breathing rate or effort
Change in the droppings
urates white or yellowish
Abnormal skin color or shedding
Parasites on the skin or in the feces
Weakness