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Hours & Contact
Monday & Wednesday: 8:00am - 7:00pm
Tuesday & Thursday: 8:00am - 6:00pm
Friday: 8:00am - 5:00pm
Saturday: 8:30am - 2:00pm
Sunday: Closed
(856) 256-8996
[email protected]
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Avian History Form
Name
First
Last
Email
Animal Details
Avian name or identification
Common or scientific species name
Date of Birth
Age
Sex
Male
Female
Unknown
Determined by
DNA
Endoscopy
Visual
Other
Enter 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?
Yes
No
Please give details
When did your bird last molt?
How often has your bird been molting?
Is your bird vaccinated?
Yes
No
Please give details
Does your bird get wing trimmed?
Yes
No
Please give details
Do you have other birds or pets?
Yes
No
Please give details
Have you or your bird had any contact with other birds in the last 30 days?
Yes
No
Please give details
When was the last bird added to your collection?
Reason For Presentation Today
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?
Yes
No
If Yes, Please give details (What was used, dosage, how often, duration)
Have you noticed any change in your bird’s behavior?
Yes
No
Please give details
Have any other animals or persons in the household had any illness in the last 30 days?
Diet
How often do you feed your animal?
Indicate which foods are eaten and in what amounts (by number, weight, or approx. volume)
Seed Mixture
Brand and Amount?
Pellets
Brand and Amount?
Fruits and/or vegetables
Brand and Amount?
Meat
Type and Amount?
Meat Options
Freshly Killed
Frozen / Thawed
Live Prey
Treats
Type and Amount?
Other
Type and Amount?
Do you use any nutritional supplements?
Yes
No
Please give details
Have you noticed any changes in feeding or drinking behavior? Please give details;
Have you noticed any changes in droppings (fecal material, urine and urates)? Please give details:
Cage Enviroment
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
Please Give Details
Are bathing/spraying facilities provided?
Yes
No
Please give details
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?
Inside
Outside
Is the animal supervised when out of the cage?
Yes
No
Please give details
Does your bird have regular exposure to sunlight?
Yes
No
Frequency and length of time
Is your bird exposed to full spectrum (UVA and UVB) lighting?
Yes
No
Brand
What is your bird’s light/dark cycle?
Does anyone in the household smoke?
Yes
No
Do you use any aerosolized products?
Yes
No
Do you have non-stick cookware?
Yes
No
Is your bird exposed to kitchen fumes?
Yes
No
Have there been changes in the bird’s environment in the last 3 months?
Yes
No
Please give details
Is there anything else you would like done today?
Nail Trim
Wing Trim
Beak Trim
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