Owner Information

Name *

First

Last

Email *

Phone Number *

Animal Details

Name or Identification *

Common or Scientific Species Name *

Date of Birth

Approximate Age *

Sex *

Origin *

How long have you had this animal? *

From where did you obtain this animal? *

Does your reptile have a reproductive history? *

When did your reptile last shed? *

How often has your reptile been shedding? *

Do you have any other reptiles or pets? *

Have you or your reptile had any contact with other reptiles in the last 30 days? If yes, please give details: *

When was the last reptile added to your collection? *

Reason for Presentation Today

How

What is the primary complaint, or what signs have you noticed? How long have these problems been present? *

What health problems has your reptile had previously? *

Has your reptile received any treatment in the last 30 days?

Have you noticed any change in your reptile's behavior?

Have any other animals or people in the household had any illness in the last 30 days? If yes, please give details: *

Cage Environment

What type of cage is used? *

What is the cage size? *

What is the cage made of? *

Is there additional ventilation (grills or mesh)? If yes, please give size/details.

What décor and furnishings are present (including bottom substrate)? *

How often is the cage cleaned? *

What cleaning/disinfectant agents are used? *

Are bathing facilities provided? If yes, please provide details. *

Are the heat sources screened from the animals? *

What heating equipment is used? *

Can the animals touch or access the heat source? *

Is additional lighting provided inside the cage? *

Are the lights screened from the animals? *

Can the animal(s) touch or access the lights? *

How many hours of light are provided each day? *

Is there ever access to direct sunlight (not through glass or plastic)? *

Do you measure the humidity in the cage? *

What are the daytime temperatures?

Hottest Area, Basking Area *

Coolest Area *

What are the nighttime temperatures?

Hottest Area, Basking Area *

Coolest Area *

Are the above temperatures measured using a thermometer?

Does anyone in the household smoke? *

Do you use any aerosolized products? *

Have there been changes in the reptile's environment in the last 3 months? *

Diet & Nutrition

How often do you feed your animal? *

Please detail the type and amount fed (per feed) from the above: *

Do you feed any wild animals to your animal? *

Any other food items fed? Please give details. *

Do you use any nutritional supplements? *

What water supply do you provide? *

How is water provided? *

How often is the water changed? *

Do you use any water supplements? *

Have you noticed any changes in feeding or drinking behavior? Please give details *

Have you noticed any changes in droppings (fecal material, urine, urates)? Please give details. *

Any other comments or information:

Clinic Policies

Twin Cities Veterinary Clinic

Appointment Policies

We require 24 hours’ notice for appointment changes. Our schedule is often full, so timely cancellations help us care for sick and injured pets. Missed, late, or last-minute cancellations may be charged a no-show fee. Late arrivals may need to reschedule. Any fees must be paid before future services.

Same-Day / Work-In / Emergency Visits

Same-day, work-in/walk-in, and emergency appointments may include additional fees and longer wait times. We are not a walk-in clinic and operate primarily by appointment.

Check-In & Arrival

New patients and those needing health certificates should check in 15-30 minutes early and provide prior medical records in advance. Dogs must be leashed; cats and small pets should be in carriers. Pets and children under 12 must be supervised at all times.

Sick Policy

If you have respiratory or flu-like symptoms or recent COVID-19 exposure, please notify us before your appointment. We may ask you to wait in your vehicle while we bring your pet inside. Masks are available on request, and staff can mask upon request.

Payment Policy

Payment is due at the time of service. We accept major credit cards, CareCredit, and cash. We do not offer payment plans. Please discuss financial limits with the veterinarian before treatment. More information is available on our Financial Assistance page on our website at twincitiesvet.com.

Prescription Refills

Please allow 24—48 hours for refill processing. You will be notified when medications are ready. Pets must be current on their annual exam for prescription authorization. We do not work directly with online pharmacies, but written prescriptions are available. Medications can be mailed for an additional fee.

Vaccinations

Patients must be up to date on required vaccines. Rabies vaccination is required by Alaska law. If you have concerns, speak with a veterinarian; medical exceptions may be discussed.

Zero-Tolerance Abuse Policy

We reserve the right to refuse service. Harassment, threats, abusive language, aggressive behavior, or actions that disrupt our staff, clients, or patients will not be tolerated. Clients may be asked to leave immediately, and law enforcement may be contacted if necessary.

Privacy Policy

We do not share personal information with third parties. Client and patient information is kept strictly confidential and is only released with the owner's consent.

Policy agreement *

I agree to the above policies.

Signature *

Clear Signature

Printed Name *

Date *

Reptile & Amphibian History

Help Us Prepare for Your Reptile or Amphibian’s Visit

Submit Your Reptile & Amphibian History Form

Owner Information

Animal Details

Reason for Presentation Today

Cage Environment

Diet & Nutrition

Clinic Policies

Schedule Your Pet’s Visit Today

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Location

Contact Information

Hours