Avian History Form – Kensington Bird & Animal Hospital

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Avian History Form

Owner's Name*
First Last
Pet's Name*
First Last
Breed (if known)
Color
Gender*
- Male
- Female
- Unknown
Age (if known)
Is your pet:*
- Wild caught
- Domestically bred
- Imported
Where did you get your pet?*
- Breeder
- Pet Store
- Friend/Family
- Rescue
- Found/caught
- Other
If other, please specify:
What type of enclosure?*
- Mesh/wire cage
- Aviary
- Free range
- Coop
- Specific room
- Other
If other, please specify:
What type of perches do you use? (check all that apply)*
- Natural branches
- Plastic
- Metal
- Rope
- Sand
- Stone
- Paper
- Other
If other, please specify:
Does your pet have a cage mate?*
- Yes
- No
What type of substrate do you use?*
- Newspaper
- Paper towel
- Corn cob
- Sand paper
- Other
If other please specify:
How is water offered:*
- Bowls
- Bottles
Do you cover the cage at night?*
- Yes
- No
How many hours of sleep?*
Diet:*
- Pellets
- Seed Mix
- Veggies/Fruit
- Table scraps
If pelleted diet, what brand?
Does your bird bathe? How?
- Spray bottle
- Shower
Has your pet been tested for the following?
- Psittacosis
- PBFD (beak and feather disease)
- Fecal Analysis
- PDD
Does your bird have any other health issues?
Has the bird been seen by another veterinarian?
- Yes
- No
If yes, please include name and phone number of veterinarian:
Please upload photo of cage setup (optional):

Contact.

977 Farmington Ave
Kensington, CT 06037

Phone: (860) 828-7736

Fax: (860) 829-0594

Hours.

Monday – Friday
8:00am – 5:00pm

Saturday
8:00am – 12:00pm

Sunday
Closed

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About Us
Emergency Care
Clinic Forms
Services
Pet Health
Contact Us
- Make An Appointment
Injured Wildlife