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Avian History Form

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Avian History Form

Your pet will be examined when the doctor’s schedule allows. Critical patients will be examined immediately. Pick up times cannot be guaranteed, but we will try our best to accommodate your schedule.

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Animal Details

Sex:(Required)
Spayed/Neutered(Required)
Determined by:

Origin(Required)
Does this bird have a reproductive history?(Required)
Is your bird vaccinated?(Required)
Does your bird get wing trimmed?(Required)
Do you have other birds or pets?(Required)
Have your or your bird had any contact with other birds in the last 30 days?(Required)

Reason for Presentation Today

Has your bird received any treatment in the last 30 days?(Required)
(what was used, dosage, how often, duration)
Have you noticed any changes in your bird's behavior?(Required)

Diet

Indicate which foods are eaten and in what amounts (by number, weight, or approx. volume)(Required)
Do you use any nutritional supplements?(Required)
What water supply for you provide?(Required)
How is water provided?(Required)
Do you use any water supplements?(Required)

Cage Environment

Where is the cage located?(Required)
What decor and furnishings are present?
Are bathing/spraying facilities provided?(Required)
Is the animal supervised when out of the cage?(Required)
Does your bird have regular exposure to sunlight?(Required)
Is your bird exposed to full spectrum (UVA and UVB) lighting?(Required)
Does anyone in the household smoke?(Required)
Do you use any aerosolized products?(Required)
Have there been any changes in the bird's environment in the last 3 months?(Required)