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Avian History Form
When you submit this form, it will not automatically collect your details like name and email address unless you provide it yourself.
Pet's Name (first and last)
*
Your Full Name
*
Your Email Address
*
Species
*
Age (if unknown please state UNK)
*
Sex
*
Sex
A
Male
B
Female
C
Unknown
How long have you had your bird and where did they come from?
*
Type and size of cage. If you have an unusual or home made enclosure we
encourage bringing pictures at the time of the appointment to show the doctor!
What type of cage furniture and toys does your pet have?
How frequently is the enclosure cleaned and what disinfectant is used?
What type of food is fed? Please list brands and in order of frequency, main portion
of diet to occ. treat.
How long has your bird been eating this diet?
How often and how much are you feeding your pet?
When was the last time your pet ate?
What type of water source does your pet have?
Is your pet housed alone or with any other birds?
If housed with other birds, are there any new additions to the group?
Is your bird allowed to fly around the house?
Is your bird allowed to fly around the house?
A
Yes
B
No
I
s your bird allowed outside?
Is your bird allowed outside?
A
Yes
B
No
Has your bird ever laid eggs? If yes, when was the last time she laid? Please
respond N/A if not applicable
Please list any medications or supplements your bird may be currently receiving
Has your pet had any prior medical problems? If so, please elaborate.
What is the reason for your pet being seen today? If sick, please include duration of
sickness.
Do you have any specific questions
for the doctor regarding your pet? We look
forward to meeting your feathered little friend!
Submit