Pre-Visit History Form

Before you begin, please be aware that you may be asked to upload pictures, if possible. It may be helpful to scroll down to see what pictures are required beforehand. This form is lengthy and will take some time to complete, but it will help save time during your upcoming appointment.

Your Full Name*

First NameLast Name

What is the date of your appointment?

Date

Who is your pet's appointment with?*

Your Pet's Name*

Please confirm your email address*

example@example.com

Cell Phone Number*

Area CodePhone Number

Husbandry:

What species / breed is your pet?*

Where did you purchase / adopt your pet?

How old was your pet when you purchased / adopted?

Are you the pet's first owner?*

YesNo

Do you have other pets in your home? If so, what type(s), are they caged, and do they have contact with this pet.

Where does you pet live?*

IndoorOutdoorBoth indoor and outdoor

Describe cage; size, shape, material, floor (solid / wire), location?

If possible, please upload a few photos of the habitat or enclosure. Otherwise, you can bring these with you to your appointment.

Browse Files

What type of bedding / substrate? Changed how often?

What type of room / window lighting? How many hours of light is pet exposed to in the room?

Heat gradient (hottest and coolest temps) in cage? Day vs. night? How is this monitored?

Typical temperature range of room in which cage is kept? Does this change seasonally?

Cage furniture: perches (types,) bowls, hides, cuttlebone, toys, branches, hammocks, other? Cleaned when / how?

How is water provided? Bowl, dripper bottle, changed how often, what type of water?

Diet: Amount / frequency / brand of seed, sprouted millet, pellets, vegetables, fruits, seeds, treats, other?

If possible, please upload a few photos of the diet brand, water container, and feeding setup. Otherwise, you can take some and bring them to your appointment.

Browse Files

Any meat / animal products? Type, amount, frequency.

Medications / supplements: Brand, dose, frequency, last given?

Socialization / handling: Who cares for the pet? Favorite person? How much time out of cage on average, is this observed or unobserved? Grooming / play? Time outdoors, describe?

Is your bird flighted? Time out of cage, allowed to fly. Wings trimmed, by who, how often?

Medical History:

What brings you in today?*

Wellness visitMedical visit

Symptoms: Onset, duration, severity, progression, other pets or people affected?

Has there been a change in the diet, cage, surroundings (home), cage mates, caretaker, or routine that may have caused the onset of symptoms?

Possible trauma, toxin, ingestion of atypical food, exposure to smoke / fumes / chemicals?

Changes in appetite, drinking, urination, feces / droppings? Describe:

Any measured or suspected weight gain / loss?

Changes in: activity level or behavior / routines? Describe:

Changes in respiratory rate, effort, or sound?

Changes in coat? Lesions, feather loss, itching?

Changes in mobility, limping, suspected pain when handled? Describe:

Has your pet laid eggs? How many eggs / how often? Any difficulty?

Please download our app prior to your visit.

Avian Medical History