Avian History Form

Owner's Name*

First Last

Pet's Name*

First Last

Breed (if known)

Color

Gender*

Age (if known)

Is your pet:*

Where did you get your pet?*

If other, please specify:

What type of enclosure?*

If other, please specify:

What type of perches do you use? (check all that apply)*

If other, please specify:

Does your pet have a cage mate?*

What type of substrate do you use?*

If other please specify:

How is water offered:*

Do you cover the cage at night?*

How many hours of sleep?*

Diet:*

If pelleted diet, what brand?

Does your bird bathe? How?

Has your pet been tested for the following?

Does your bird have any other health issues?

Has the bird been seen by another veterinarian?

If yes, please include name and phone number of veterinarian:

Please upload photo of cage setup (optional):