Avian Intake Questions

If you’ve completed the questionnaire for this pet within the last 24 hours, kindly inform a staff member. If it has been more than 24 hours, we are requiring that you fill out the form again. This helps us ensure we provide the best care possible for your pet. Thank you for your understanding and cooperation!

Owner Name*

First NameLast Name

Pets Name*

Pets Sex*

Pets Age*

Have You Ever Owned A Bird Before?*

Reason For Today's Visit*

Your Pets Diet

What Diet Do You Feed Your Bird & What Percentage Of The Following:

Seed Type*

Percentage Of Seed Diet*

Pellet Type*

Percentage Of Pellet Diet*

Veggies Given*

Percentage Of Veggie Diet*

Fruit Given*

Percentage Of Fruit Diet*

Table Food / Favorite Food Given*

Percentage Of Table / Favorite Food Diet*

Is Your Pet On Any of The Following:

Medications?*

Vitamins/Supplements?*

Calcium?*

Where Is the Bird Kept In The Home?*

Is Your Pet Kept Near A Window Or Air Vent?*

What Type Of Cage Is Your Bird In & What Is In The Cage (Toys, Perch Type, Etc)?*

Picture Of Cage*

Please be sure to include the entire cage

When Did You Purchase/Receive Your Bird?*

Where Was Your Bird Purchased From?*

Are There Any Other Birds In The Home & Where Are They Kept?*

Have Any Humans In Your Home Been Sick In The Last 2-3 Weeks?*

Has Your Bird Every Been Sick & If So, What Was The Diagnosis & When Was It Given?*

Has Your Bird Had Any Changes In Their Droppings (Watery, Blood, Loose, Size Difference, Or Odor)?*

If Your Bird Is A Female, When Was The Last Time Your Bird Passed An Egg

If A Male, Write N/A

Thank You For Taking The Time To Fill This Out While You Wait For Your Pet To Be Seen. We Will Be With You Shortly! Dont Forget To Push Submit!

Avian Questionnaire