Exotic

Important Notice:
New patient requests are being accepted on a case-by-case basis.
Please complete the form below, and we will be in touch.

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Exotic Pet Intake 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

Phone

Address

City/Town

State/Province

ZIP/Postal Code

Pet Information

Pet's Name

Species* (e.g., bearded dragon, parrot, hedgehog)

Age (approximate if unknown)

Sex

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

Please upload any relevant files (e.g., vet records, vaccination history, or photos of your pet’s condition)

One file only.
50 MB limit.
Allowed types: pdf, doc, docx, jpg, jpeg, png.

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

Anything Else We Should Know?

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