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 (approximate size/weight is very useful to include), invertebrates, plants, birds/mammals (if applicable) etc are intentionally kept in the same pond with the aquatic pet you brought for an exam?
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? *
Pond Dimensions (width/length/depth) and Size (gallons) *
How often do you do routine water changes in your pond? *
How many gallons of water do you replace at each water change? *
How often do you check your pond 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 pond? *
After treating your water how long do you wait to use it in your pond? *
Dissolved Oxygen In Pond (please include units of measurement- i.e. ppm, mg/L) *
Salinity (write N/A if not applicable): *
pH *
kH *
Nitrite *
Nitrate *
Ammonia *
Pond 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? *
Pond substrate?
Live Plants?
Do you quarantine your fish or other additions to your pond prior to adding them? If so, how and for what length of time? *
How long do you quarantine stock (fish, invertebrates, plants, etc) before adding them to your pond? *
Approximate date of last new addition of anything (fish, invertebrates, plants etc) to your pond? What was it? *
If other, please specify *
Mechanical Filtration Used (please describe) *
Chemical Filtration (please describe) *
BioFilter Used and Size (please specify) *
Do you use anything in your pond to create water movement/flow and break the water surface tension (ex. Water falls, power heads, etc)? How many hours a day do these features operate? *
Describe Pond Filtration System: *
How often do you maintain your pond filtration system and what do you do to maintain it? *
What is your pond turnover rate (gpm) through your filtration system/sump? *
