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Exotic
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Exotic Pet Intake Form
Please enable JavaScript in your browser to complete this form.
Please fill out all required fields (marked with *) to help us better understand your exotic pet's needs. This form is for small to medium exotic pets only (e.g., reptiles, birds, small mammals, amphibians, etc.). Large animals (e.g., big cats, bears) and pigs are not eligible.
Owners Information
Name
*
First
Last
Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
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State
Zip Code
Pet Information
Pet's Name
*
Species* (e.g., bearded dragon, parrot, hedgehog)
*
Age (approximate if unknown)
Sex (if known)
Male
Female
Unknown
Date of Acquisition
Source of Pet (e.g., breeder, pet store, rescue)
Health and Care Details
Current Diet
*
Housing/Enclosure Description (e.g., tank size, temperature, humidity)
Known Health Issues (if any)
Last Veterinary Visit (date and reason)
Veterinary Records
Upload Veterinary Records/Documents
Click or drag files to this area to upload.
You can upload up to 10 files.
Please upload any relevant files (e.g., vet records, vaccination history, or photos of your pet’s condition)
Request Details
What Are You Requesting? Please provide a brief description of your request (e.g., health checkup, dietary advice, behavioral consultation, etc.).
*
Additional Notes
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