denverreception@theexoticpetvets.com
7120 E. Hampden Ave. St 101
Denver, CO 80224

Avian History Form (CO)

Please fill this out before you bring your feathered friend into our office. This will speed up the intake process and let us get to work sooner.

1 Start 2 Complete

General History

First Name *

Last Name *

Phone *

Email *

Your Pet's Name *

Species *

Color *

Hatch/birth date or approximate age? *

Sex *

Male

Female

Unknown

How was sex determined? *

DNA blood test, surgical, laid eggs, color dimorphic?

When and where did you acquire your pet? *

Any form of identification? *

Microchip, band, none?

Do you have any other pets? If yes, please specify: *

Housing

What type of cage does your bird have? *

Briefly describe the cage and where it is located.

How often is the cage cleaned? *

Method/frequency of cleaning food/water dishes? *

Are there any toys in your bird’s cage? Briefly describe. *

Does your bird spend time outside the cage? If so, are they supervised? *

Does your bird have a full spectrum (UVB) light? If so, what brand? *

Do you cover the bird at night? How many hours of darkness does your bird have each day? *

Have there been any changes in the bird's environment? *

Does your bird go outside? *

Yes

No

Diet

What kind of foods do you feed your bird and in what overall percentages? *

Pellets/Seed mix/Fruits/Veggies/Treats/Other? Please specify types/brands as well.

Do you give your bird supplements? *

Any recent diet changes or new foods? *

Yes

No

What percentage of your bird's diet is human foods? *

How is water offered? *

(bowl/sipper bottle/other)

Medical History

Please list any previous medical problems: *

Has your bird ever been tested for infectious diseases/viruses? *

List tests if yes.

Has your bird been recently exposed to other birds? *

ie new birds, boarding, etc.

Yes

No

Have there been any changes in your bird's droppings? *

Does your bird have any behavior problems? Please describe: *

Are there any smokers in the house? *

Yes

No

Any current or recent medications? Please list types and dosages: *

General

Is your bird groomed regularly? Who does the grooming? *

Do you bathe your bird? If so, how often? *

Do you have pet insurance? *

Yes

No

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Avian History Form (CO)