Name: Paws & Claws Animal Hospital
Address: 5333 Oleander Drive, Wilmington, NC, 28403
Telephone: (910) 399-3768

AQUATIC HUSBANDRY FORM

Aquatic Husbandry Form

Please complete this form in its entirety and click submit once finished.

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Client Name:

Animal Name:

Email:

Phone:

Animal Species:

Age:

Sex:

Origin:

How long have you had this animal?

From where did you obtain this animal?

Why are you presenting this animal? What signs have you seen?

Do you operate a quarantine system? If yes, please give details.

What other species are present? Please list all species. If none, type N/A.

Has any disease been diagnosed in ANY fish or this tank previously? If yes, please give details.

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Have you treated with any of the following products? If yes, please give details including dose and response.

Formalin, formaldehyde:

Potassium permanganate:

Copper:

Salt (freshwater fish only):

Malachite green:

Antiparasitics (e.g. fenbendazole, metronidazole, praziquantel:

Antibiotics (e.g. oxytet, nitrofurazone, sulphonamides):

What water conditioners have been used in the last 3 months?:

What type of aquarium is used?

What is the salinity?

What is the water temperature?

What water source is used?

What type of water change system do you operate?

How often do you perform water changes?

What percentage of the water is changed?

Do you use biological filtration? If yes, please give details.

Do you use mechanical filtration (e.g. sponge filters)? If yes, please give details.

Do you use chemical filtration (e.g. activated charcoal, chlorine, etc.) If yes, please give details.

Do you use ozone?

Do you use protein skimmers? If yes, please give details.

Do you oxygenate the water? Give details.

What decor and furnishings are present? (inc. bottom substrate)

Are plants present? Please give details.

Do you quarantine plants?

When were plants last added to your aquarium or pond?

Is additional lighting provided inside the cage?

What type of lighting is used?

Number, make, model and manufacturer?

When was the light last replaced?

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

If yes, how many hours per day or per week?

Do you measure ammonia? If so, please provide most recent results.

Do you measure nitrie? If so, please provide most recent results.

Do you measure nitrate? If so, please provide recent results.

Do you measure pH? If so, please provide recent results.

Do you measure water oxygen? If so, please provide most recent results.

How often is the aquarium cleaned? What cleaning agents/disinfectants are used?

Please provide details such as the make & manufacturer for pellets/flakes, type for other options, and amount fed daily:

If you provide another diet not listed, please provide details.

Do you provide any nutritional supplements? Please provide details.

202 Giles Ave., Wilmington, NC 28409

info@pawsclawsah.com
(910) 399-3768

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