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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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