Phone Number
Email *
Pet's Name (if applicable)
What Species Are You Bringing For An Exam? *
Where has your pet been seen previously? *
Main Concern/Problem for this pet *
Have you tried any at home treatments/remedies or medications on your pet already to address the problem they have? If so what and for how long? *
Any difference noted with what you did? *
Are there other affected individuals in your collection showing the same signs/symptoms or have different abnormal symptoms as the pet you're bringing today (please describe and include species affected if different then your pet coming for an exam)? *
How long have you owned this aquatic pet? *
Size when purchased (approximate)? *
Current length (approximate)? *
What other fish, invertebrates, plants etc are housed in the same display tank with the aquatic pet you brought today?
What do you feed your pet? *
How often do you feed your pet? *
Is your pet currently eating? *
When is the last time they ate and what did they eat or show interest in? *
Aquarium Size (gallons) *
How many gallons of water do you replace at each water change? *
How often do you do routine water changes? *
How often do you check your tanks water parameters (pH, salinity, kH, Nitrate, Nitrite, Ammonia)? *
What water source do you use for your water changes (ex. Tap water, well water, RO water, etc)? *
Do you treat your water with a product to remove chlorine/chloramine prior to adding it to your aquarium? *
After treating your water how long do you wait to use it in your tank? *
Salinity *
pH *
kH *
Nitrite *
Nitrate *
Ammonia *
Tank Temperature *
If so, how much and how often? *
How often (if applicable) are these additives monitored with a test kit to determine levels before/after adding? *
Tank substrate?
Live Plants?
How long do you quarantine stock (fish, invertebrates, plants, etc) before adding them to your tank? *
What was the last new addition to your display tank? *
If other, please specify *
Type of Filtration System *
What type of lighting do you have and what is the length of time it is on? *
What is your tank water turnover rate through your filtration system/sump? *
Or describe the setup (ex. Mounds of live rock, bare bottom with no rocks, PVC pipe for fish to hide in, etc)
