Please fill out the below history form about your sick pet fish before the visit with Dr. Palmeiro.

*Please type your name and Email address
*Phone and Street Address
*1. How long has the tank/pond(s) been in operation?
*2. How many gallons in the tank/pond(s)?
*3. What type of lighting (natural, incandescent, fluorescent, other)
*3. How many fish are in the tank/pond?
*4. Please describe the filtration. Type? How often is it cleaned?
*5. Is there a bottom substrate? What type?
*6. What kind of plants are in the tank/pond?
*7. Is there a bottom drain, surface skimmer or protein skimmer
*8. Is there a UV sterilizer?
*9. What is the source of water? Is it dechlorinated?
*10. How often is the water tested? What test kits are used?
*11. What were the most recent readings for ammonia? pH? nitrite? nitrate? alkalinity? other?
*12. How often is water changed? What quantity?
*13. What water treatments are used - softener, ion exchanger, sodium bicarbonate, potassium permanganate etc.? Include frequency
*14. Please name the types/brands of feed (include live food if applicable).
*15. How much food is given and how often?
*16. What species of fish are kept in the tank/pond? What species are affected?
*17. Have there been any recent new fish introductions (how long ago and what)?
*18. If nothing recently, when was the last new fish introduced into the tank/pond?
*19. Are new fish quarantined? For how long?
*20. Please describe what signs the sick fish are showing.
*21. When did the signs first start?
*22. How many fish are affected? Have any deaths occurred?
*23. Please describe what treatments have been attempted. Include names/ingredients/duration of treatment, and response to treatment.
*24. Please describe any historical health problems (besides for the current problem) that you have had with your fish. Include treatments and response.
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