Breed / Type
Wild caught or captive bred?
Length of time owned
Does your bird roam freely in the house?
Is your bird allowed outside?
Is your bird housed by itself? If no, please specify.
Are there any other pets? If yes, please specify.
How many hours does your bird get outside the cage?
Describe your enclosure, including size, type/material of cage, number of perches, toys, etc. PLEASE BRING PICTURES
How often is the cage cleaned?
What type of disinfectant is used?
If covered, for how many hours at night?
Is there a separate cage at night or is the cage covered at night?
Is there any bedding material? If yes, please specify.
Do you bathe/mist your bird? If yes, please specify.
Any recent changes in housing? If yes, please specify.
Please list the items included in the diet, brand and amount/frequency fed.
How is water offered?
Are there any treats/table scraps offered? If yes, please specify.
Are there any supplements used? If yes, please specify.
Have there been recent changes to diet? If yes, please specify.
Secondary Owner's Name
How Did You Hear About Us?
Previous Veterinary Clinic
Any allergies or pre-existing conditions?
Have you scheduled an appointment with us?
When is your appointment scheduled for?
Date of Most Recent Vet Visit