Avian Form

My name is:*

My bird's name is:*

General Information

Is your bird a pet or breeder?

Pet

Breeder

Where did you get your bird?*

How long have you had your bird?*

Has your bird been sexed in the past?

Yes

If yes: DNA or Endoscopic?

DNA

Endoscopic

Vaccines/Medications/Health

Has your pet seen a veterinarian before? **If so, please have records sent to animalhouseofchicago@yourvetdoc.com in advance or bring them to your appointment*

Does your pet have any chronic health issues?*

Has your bird had any vaccines in the past (i.e. polyoma)?*

Any medications or supplements given? *Please be as specific as possible.**

Enclosure

What kind of enclosure do you have? What material? What are the dimensions?*

What substrate is used? How often is it changed?*

If your bird has time outside the enclosure, how long are they out? Is the time supervised?*

What type of perches do you have (rope, wood, sandpaper, etc.)?*

Do you give your bird toys?*

Where in the home is the enclosure located?*

Are their other birds in the enclosure? If so, what kind? How many?*

Are there other pets in the household? What kind?*

Feeding

Please list the quantity, brand, and type of each food source.

Pellets:
Seeds/Nuts:
Fruits/Veggies:
Treats:
Other:

Any recent diet changes? If so, what did you change?*

Do you give tap or purified water?*

How often is food & water changed?

Please list any cleaning agents used.

Behavior

Does your bird have any history of behavioral issues (e.g. feather picking)? If so, please describe.*

Avian Form

My name is:*

My bird's name is:*

General Information

Is your bird a pet or breeder?

Where did you get your bird?*

How long have you had your bird?*

Has your bird been sexed in the past?

If yes: DNA or Endoscopic?

Vaccines/Medications/Health

Has your pet seen a veterinarian before? **If so, please have records sent to animalhouseofchicago@yourvetdoc.com in advance or bring them to your appointment*

Does your pet have any chronic health issues?*

Has your bird had any vaccines in the past (i.e. polyoma)?*

Any medications or supplements given? *Please be as specific as possible.**

Enclosure

What kind of enclosure do you have? What material? What are the dimensions?*

What substrate is used? How often is it changed?*

If your bird has time outside the enclosure, how long are they out? Is the time supervised?*

What type of perches do you have (rope, wood, sandpaper, etc.)?*

Do you give your bird toys?*

Where in the home is the enclosure located?*

Are their other birds in the enclosure? If so, what kind? How many?*

Are there other pets in the household? What kind?*

Feeding

Please list the quantity, brand, and type of each food source.

Any recent diet changes? If so, what did you change?*

Do you give tap or purified water?*

How often is food & water changed?

Please list any cleaning agents used.

Behavior

Does your bird have any history of behavioral issues (e.g. feather picking)? If so, please describe.*

Additional Information

Do you exercise your bird? If so, how do you do this? Outside time?*

Is your bird flighted (i.e. can they fly)?*

Does your bird get bathed? If so, how and how often?*

Is there anything else you would like us to know about your bird?

Avian Form

My name is:*

My bird's name is:*

General Information

Is your bird a pet or breeder?

Where did you get your bird?*

How long have you had your bird?*

Has your bird been sexed in the past?

If yes: DNA or Endoscopic?

Vaccines/Medications/Health

Has your pet seen a veterinarian before? **If so, please have records sent to animalhouseofchicago@yourvetdoc.com in advance or bring them to your appointment*

Does your pet have any chronic health issues?*

Has your bird had any vaccines in the past (i.e. polyoma)?*

Any medications or supplements given? Please be as specific as possible.*

Enclosure

What kind of enclosure do you have? What material? What are the dimensions?*

What substrate is used? How often is it changed?*

If your bird has time outside the enclosure, how long are they out? Is the time supervised?*

What type of perches do you have (rope, wood, sandpaper, etc.)?*

Do you give your bird toys?*

Where in the home is the enclosure located?*

Are their other birds in the enclosure? If so, what kind? How many?*

Are there other pets in the household? What kind?*

Feeding

Please list the quantity, brand, and type of each food source.

Any recent diet changes? If so, what did you change?*

Do you give tap or purified water?*

How often is food & water changed?

Please list any cleaning agents used.

Behavior

Does your bird have any history of behavioral issues (e.g. feather picking)? If so, please describe.*

Additional Information

Do you exercise your bird? If so, how do you do this? Outside time?*

Is your bird flighted (i.e. can they fly)?*

Does your bird get bathed? If so, how and how often?*

Is there anything else you would like us to know about your bird?

Any medications or supplements given? *Please be as specific as possible.**