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Owner's Name
*
First
Last
Breed Name
*
Pet's Name
*
Date of Birth
*
Date Format: MM slash DD slash YYYY
Please select your birds sex
*
Male
Female
Unknown
How was your birds gender determined?
*
DNA
Endoscopy
Visual
Other
If other is selected, please explain:
How long have you had this bird?
*
Where did you obtain this bird?
*
Do you have other pets?
*
Yes
No
If answered yes, please provide details:
Have you or your bird had contact with any other pets in the last 30 days?
*
Yes
No
If answered yes, please provide details:
Does this bird have a reproductive history?
*
Yes
No
If answered yes, please provide details:
When did your bird last molt?
*
How often has your bird been molting?
*
Does your bird get his/her wings trimmed?
*
Yes
No
If answered yes, please provide details:
When was the last bird added to your collection?
*
What is you primary concern? What signs/symptoms have you noticed? How long have these problems been present?
*
Does your bird have any prior health issues?
*
Yes
No
If answered yes, please provide details:
Has your bird received any treatment within the last 30 days?
*
Yes
No
If answered yes, please provide details (medication used, dosage, how often, duration etc. )
Have you noticed any changes in your birds behavior? ( Not eating/drinking, lethargic, etc. )
*
Yes
No
If answered yes, please provide details:
Have any other animals or persons in your household had any illness within the last 30 days?
How often do you feed your bird?
*
Please indicate what you feed your bird
*
Seed Mixture
Pellets
Fruits/vegetable
Meat
Treats
Other
Nutritional Supplements
Water Supplements
Please describe your pets diet/supplements in more detail such as brand, amount (by number, weight or approx. volume/%), type ( like frozen or fresh),etc.
*
What water supply do you provide?
*
Tap water
Bottled Water
Rain/River water
Have you noticed any changes in your birds droppings (fecal material, urine)?
*
Yes
No
If answered yes, please provide details:
In which room of the house is your birds cage located?
*
Are bathing/spraying facilities provided?
*
Yes
No
What is your birds light/dark cycle?
*
What percentage of time does your bird spent inside/outside of its cage?
*
Is your bird supervised when out of its cage?
*
Yes
No
Does anyone in the household smoke?
*
Yes
No
Do you use any aerosolized products?
*
Yes
No
Have there been any changes in your birds enviroment in the last 3 months?
*
Yes
No
If answered yes, please provide details:
Please add any other comments/information here:
Home
About Us
Location & Hours
Our Veterinarians
Our Care Team
Office tour
Contact
Services
Preventative Health Care
Diagnostic/Laboratory
Dental Services
Surgical Services
Exotic Health Care
Additional Services
Medical Services
Pet Care
Patients
Forms
Payment Options
Pet Health
Pet Health Library
Pet Health Checker
Pet Insurance Info
News
New Clinic Updates
Fear Free
Pharmacy