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Animal Medical Professionals
Vet Clinic Ooltewah & Chattanooga
423-238-5870
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423-238-5870
423-238-5870
Home
About Us
Our Doctors
Testimonials
FAQ
Join Our Team
Services
All Services
Diagnostic Laboratory
Pet Surgery
Endoscopy & Ultrasound
Pet Medical Boarding Services
Angel Fund
Online Pharmacy
Forms
Gallery
Blog
Contact
Avian History Form
You are here:
Home
Avian History Form
OWNER PERSONAL INFORMATION
First Name
*
:
Last Name:
Email
*
:
Patient Information
Avian name or identification:
Common or scientific species name:
Date of birth:
Age:
Sex:
M
F
Neutered/Spayed
Unknown
Determined by:
DNA
Endoscopy
Visual
Other
Origin:
Captive bred
Wild caught import
Unknown
How long have you had this bird?:
From where did you obtain this bird?:
Does this bird have a reproductive history?:
N
Y
When did your bird last molt?:
How often has your bird been molting?:
Is your bird vaccinated?:
N
Y
Does your bird get wing trimmed?:
N
Y
Do you have other birds or pets?:
N
Y
Have you or your bird had any contact with other birds in the last 30 days?:
N
Y
When was the last bird added to your collection?:
Reason for Visit
What is the primary complaint or what signs have you noticed? How long have these problems been present?:
What health problems has your bird had previously?:
Has your bird received any treatment in the last 30 days?:
N
Y
Have you noticed any change in your bird's behavior?:
N
Y
Have any other animals or persons in the household had any illness in the last 30 days?:
Cage Enviorment
Where is the cage located?:
Inside
Outside
What is the cage made of?:
Cage size:
What kind of bedding is used?:
What décor and furnishings are present?:
nest box
Perches
Swings
Toys
Other
Are bathing/spraying facilities provided?:
N
Y
How often is the cage cleaned:
What cleaning/disinfectant agents are used:
What percentage of time does your bird spend inside and outside of its cage:
Is the animal supervised when out of the cage?:
N
Y
Does your bird have regular exposure to sunlight?:
N
Y
Is your bird exposed to full spectrum (UVA and UVB) lighting?:
N
Y
What is your bird's light/dark cycle?:
Does anyone in the household smoke?:
N
Y
Do you use any aerosolized products?:
N
Y
Have there been changes in the bird's environment in the last 3 months?:
N
Y
Diet
How often do you feed your animal?:
Indicate which foods are eaten and in what amounts (by number, weight, or approx. volume):
Seed mixtures
Pellets
Fruits and/or vegetables
Meat
Meat condition:
Freshly killed
Frozen/thawed
Live prey
Treats
Other
Do you use any nutritional supplements?:
N
Y
What water supply do you provide?:
Tap water
Bottled water
Rain/river water
How is water provided?:
Bowl
Dripper system
Spray
How often is the water changed?:
Do you use any water supplements?:
N
Y
Have you noticed any changes in feeding or drinking behavior?:
N
Y
Have you noticed any changes in droppings (fecal material, urine and urates)?:
N
Y
Upload Photo(s)
Please submit habitat photos below:
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