Fish QuestionnaireZOO/AQUARIUM GENERAL HEALTH and DIET HISTORY FORM: FISHDate Date Format: 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 InformationSpecies:Number of animals housed together:Animal InformationIf 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.Enter ID Number:Chemical birth control (y/n)Reproductively active (y/n) Tank type: Closed filtration tank system Open, flow-through system Combination systemExhibit location: Indoor only Outdoor only BothIf any part of the exhibit is located outside, is there shade provided? Yes, total Yes, partial NoneAre any of the animals currently being treated for any condition(s) or disease(s)? Yes NoIf yes, please list animal ID, diagnosed condition/disease, approximate date of diagnosis, medications.Animal IDCondition/DiseaseDate DiagnosedMedication Name, Dose, Route, Freq., Length Diet and Enrichment InformationHow are the fish fed? General broadcast feed Target/pole-fed Combination of both methodsInstructions for the following questions: Be sure the “Amount” provided is measurable. Always weigh the measured amount of food on a gram scale and provide the total gram weight for each ingredient.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.Describe all brands, product names, amounts, and frequency for ALL commercial foods offered as a part of regular diet.ManufacturerProduct NameFormAmountFrequency List all other food items offered as a part of regular diet, including leafy greens, cut vegetables, fruit, meat, eggs, insects, etc.Food itemPreparationAmount/Weight (grams)Freq per dayDays per weekPlease provide information on how the food is prepared (whole vs. chopped, cooked vs. raw, live vs. frozen/thawed, etc.), food item gram weights and measured amounts, frequency offered per day, and days fed per weekList 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)FrequencyMonths offeredAre 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.)NoAre 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 NoIf so, please describe the change made.Are any dietary supplements (vitamins, fatty acids, oils, etc.) given?YesNoIf yes, please describe brand/type, quantity, frequency.ManufacturerTypeDoseFrequency
