Fish History Form – Kensington Bird & Animal Hospital

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Fish History Form

Pet's Name*
Owner's Name*
First Last
Species*
Age - Months/Years (if known)*
Gender*
- Male
- Female
- Unknown
If you know the gender, how was it determined?
How did you acquire your pet?*
- Wild Caught
- Domestically Bred
- Imported
- Pet Store
- Other
If other, please explain:
What type of enclosure?*
- Aquarium
- Pond
- Indoor
- Outdoor
- Other
If other, please explain:
How big is the enclosure (gallons or dimensions)?*
How often do you clean the enclosure?*
Any other fish living in the enclosure?*
What type of items are in the enclosure (mark all that apply)?*
- Natural Branches
- Fake Brances
- Foliage
- Real Plants
- Stones
- Dig Box
- Hide Box
- Other
If other, please explain:
What is at the bottom of the enclosure?*
- Tile
- Rubber Mat
- Playsand
- Bare
- Gravel
- Dirt
- Moss
- Other
If other, please explain:
Do you have supplemental heat?
- Yes
- No
If yes, what type of heater?
Do you have supplemental cooling?*
- Yes
- No
If yes, what type of cooler?
What is the temperature of the water?*
What is the light cycle?*
How often is the water changed?*
How much water is changed?*
- 1/4
- 1/2
- 1/3
- Full
- Other
If other, please explain:
How often is water chemistry tested?*
Brand of water test kit?*
How often is filter media cleaned?*
Do you have an aeration system?*
- Filter
- Aerator Stone
- None
- Other
If other, please explain:
What type of lighting does or tank receive?*
- None
- UVB
- Fluorescent
- Other
If other, please explain:
What is the PH of the water?*
What type of water?*
- Dechlorinated
- Aged
- Distilled
- Tap
- Other
If other, please explain:
What additives do you put in water?*
In the case of pond fish, do you bring them inside during winter?
- Yes
- No
Has the fish been seen by another veterinarian?
- Yes
- No
If yes, please provide name and number of veterinarian
Please upload photo of enclosure (optional)

Contact.

977 Farmington Ave
Kensington, CT 06037

Phone: (860) 828-7736

Fax: (860) 829-0594

Hours.

Monday – Friday
8:00am – 5:00pm

Saturday
8:00am – 12:00pm

Sunday
Closed

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About Us
Emergency Care
Clinic Forms
- Forms
- Forms
Services
Pet Health
Contact Us
- Make An Appointment
Wildlife & Disease Outbreaks

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