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Home
Our Hospital
Our Doctors
Our Support Staff
Hospital Tour
PetDesk
Careers
AAHA-Accredited Hospital
Services
Exotic Pets
Ultrasound
Wellness Exams
Vaccinations
Microchipping
Spay & Neuter
Dental Care
Surgery
Acupuncture
Herbal Medicine
Shock Wave
View All Services
New Clients
Resources
Birthing
Download Our Free App
Donate to Paisley Paws
Forms & Helpful Links
Payment Options
Shop Online
Kitten & Puppy Kit
Pet Library
Pet Health Insurance
Pet Memorial
Contact Us
(715) 693-4560
Make an Appointment
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Avian History Form
Avian History Form
Client's Name
(Required)
Date
(Required)
MM slash DD slash YYYY
Name of Bird
(Required)
Species
(Required)
Age
(Required)
Type of Bird?
(Required)
Pet Bird
Breeder
Background Information
Length of time owned?
(Required)
Where acquired?
(Required)
Breeder
Pet Store
Other
Where was the avian acquired?
(Required)
Vaccination History
(Required)
When was last molt?
(Required)
Character of feces?
(Required)
How often is the bird handled?
(Required)
Daily
Occasionally
Never
Is the bird ever taken outside?
(Required)
Yes
No
Husbandry
Housed Indoors / Outdoors?
(Required)
Indoors
Outdoors
Where is the cage located?
(Required)
Type of Caging?
(Required)
Size of Caging?
(Required)
Galvanized?
(Required)
Yes
No
Cage Substrate?
(Required)
How often is the cage cleaned?
(Required)
What disinfectant is used when cleaning the cage?
(Required)
Types of toys/perches offered?
(Required)
Nutrition
Type of food offered:
Pellets?
(Required)
Yes
No
If yes, which brand of pellets?
(Required)
Amount fed/frequency
(Required)
Seed?
(Required)
Yes
No
If yes, which type of seed?
(Required)
Amount fed/frequency
(Required)
Fruits?
(Required)
Yes
No
If yes, which type of fruit?
(Required)
Amount fed/frequency
(Required)
Vegetables?
(Required)
Yes
No
If yes, which type of vegetables?
(Required)
Amount fed/frequency
(Required)
Types of Supplements/Treats offered?
(Required)
Water Source
(Required)
How often is water changed?
(Required)
Any other birds?
(Required)
Yes
No
If yes, please specify other birds.
(Required)
Any other pets?
Yes
No
If yes to any other pets, please specify
(Required)
Birds are housed together or singly?
(Required)
Together
Singly
If not housed together, where are other birds located?
(Required)
Any new additions to the bird population?
Yes
No
If yes to new bird population additions, please specify
(Required)
Were the new additions properly quarantined separate from rest of bird population?
(Required)
Additional Questions
Past Medical History/Problems
Current Presenting Problems
Duration of Problem
Email
This field is for validation purposes and should be left unchanged.
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