Please fill out his form and give as much information as possible. E-mail the form to me and have the

 completed form in front of you when we speak on the telephone

1. What are the beginning symptoms, how do the fish act now,

2. Which types of fish show symptoms, no symptoms and which fish already died?

4. Estimate how old are the sick fish are.

5. Were new fish added, what date, where did they come from e.g. private, dealer, chain shop etc.?

6. Were they quarantined, by whom & how long?

7. Have you changed a lot of water (more than 1/2), treated a disease or added rocks or plants recently?

8.Your Pond is:

How old, how many gallons, what size: width, length depth, what filter, how big, How many fish, number and size.

9.When was the last time you topped off the pond, changed out water, cleaned your filter.

10. What kind of water are you using: Well, City, Rain or chemically treated water.

11.Have you used any chemicals, paints, sprays or has there been any construction near the pond.

12.Have you tested your water. Which test kit did you use. What has been the water temperature  in the last week?

PH=

Ammonia=

Nitrite=

Nitrate=

Phosphate=

Oxygen=

Hardness=

Carbon dioxide=

Copper=

Iron=

Lead=

13.What brand of food are you feeding,  how much and how many times a day? Any supplemental food i.e. Oranges, Bread, Cheerios etc.. How much. Who feeds the fish?

14. Have you added any Medicines (Including Salt) to the pond in the last month---what kind?

Answer as many questions as you can, I don't expect you to know the answers to all.

How can I contact You?:

Name:

Address:

Tel #:

E-mail:

Date filled Out:

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