Fish Questionnaire ZOO/AQUARIUM GENERAL HEALTH and DIET HISTORY FORM: FISHDate MM slash DD slash YYYY Facility name:Facility address:Contact Information First name: Last name: Position: Email PhonePrimary veterinarian name (if different from above):Veterinarian contact information (phone number, email):Animal Information Species:Number of animals housed together:If applicable, please provide the following detailed information:ID NumberHouse NameSexAgeCurrent Body Weight*Current Body Condition* If applicable, please provide the following information as to reproductive status.If applicable, please provide the following information as to reproductive status.Enter ID Number:Chemical birth control (y/n)Reproductively active (y/n) Are any of the animals currently being treated for any condition(s) or disease(s)? Yes No If yes, please list animal ID, diagnosed condition/disease, approximate date of diagnosis, medications.Animal IDCondition/DiseaseDate DiagnosedMedication Name, Dose, Route, Freq., Length Exhibit Information Tank Type Closed filtration tank system Open, flow-through system Combination system Exhibit location: Indoor only Outdoor only Both If any part of the exhibit is located outside, is there shade provided? Yes, total Yes, partial None Diet and Enrichment InformationHow are the fish fed? General broadcast feed Target/pole-fed Combination of both methods Instructions for the following questions: The “amount” provided must be measured by weight, as obtained using using a gram scale For each food item the the total weight of each ingredient fed daily All food items will be assumed to be group fed, even if separate feeding location , because of the opportunity for cross-over, and consumed in equal amounts by all animals, unless otherwise specified. Possible scenarios to troubleshoot: Unlabeled cup or scoop: First measure the amount held in that cup/scoop - for example, “½ scoop” may actually represent a true 1 cup, as measured. Then weigh the volume of diet item held within that container. Abstract unit of measure (e.g. “one handful”), take one handful of the item and obtain the gram weight of that handful 5 days in a row. If different individuals are doing the feeding, make sure that each individual’s handful is represented. Then calculate the average weight (grams) per handful by summing the gram weights from each of the 5 days, and diving by 5. Provide that average weight as the “Amount” below. Commercial FeedsDescribe all brands, product names, amounts, and frequency for ALL commercial foods offered as a part of regular diet.ManufacturerProduct NameFormAmountFrequency Whole Food Items List all other food items offered as a part of regular diet, including whole prey and produceFood itemPreparationAmount/Weight (grams)Freq per dayDays per week Please provide information on how the food items are prepared (whole vs. chopped vs. steaks vs. filleted, live vs. frozen/thawed, shell on or off, head and tail on off, etc.)Other Food ItemList other food items offered for enrichment and/or daily medication purposes (e.g. training, interactive sessions, educational programs, medication administration etc.).Food itemPreparationAmount/Weight (grams)Frequency Are there any seasonal variations to the diet provided (aside from enrichment items offered)? If so, please thoroughly describe.In the last 5 years, have you ever had a nutrient analysis performed by a laboratory on either the whole diet and/or any individual food items (e.g. hay, browse, leafy greens, etc.)? Yes (If yes, please provide copies of analyses.) No Are there any food items that the animal particularly prefer? Please describe.Are there any food items that the animal do not particularly like and/or refuse? Please describe.Have you made any changes to the diet offered in the last 4 weeks?: Yes No If so, please describe the change made.Are any dietary supplements (vitamins, fatty acids, oils, etc.) given? Yes No If yes, please describe brand/type, quantity, frequency.ManufacturerTypeDoseFrequency
