• Date Format: MM slash DD slash YYYY
  • Animal 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) 
  • Animal IDCondition/DiseaseDate DiagnosedMedication Name, Dose, Route, Freq., Length 
  • Exhibit Information

  • Diet and Enrichment Information

  • 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.
  • 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 whole prey and produce
    Food 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.)
  • List 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
  • ManufacturerTypeDoseFrequency