Does your pet ever go outside? (required)
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Are your pet’s wings kept clipped? (required)
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Does your pet live primarily in a cage? (required)
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If Yes, what are the dimensions of the cage?
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If No, or if your pet is ever allowed out of cage unsupervised, where does your pet live and/or play? (i.e. what rooms)?
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Where is the cage located? (required)
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Does your pet share a cage/habitat with any other pets? (required)
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Does your pet interact or live with other pets, outside of a cage (including supervised playtime)? (required)
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What bedding / cage lining do you use in your pet’s habitat? (required)
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Is your pet separated from bedding / cage liner by a grate? (required)
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How many perches are available in the cage? (required)
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Approximately how wide are perches? (Diameter) Widest: (required)
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Approximately how wide are perches? (Diameter) Narrowest: (required)
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How many perches are sandpaper or other rough texture? (required)
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Is there a nest box or other hiding spot in cage / living area? (required)
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What sort of toys does your pet have? (required)
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Are there any live plants in your pet’s habitat, or in areas of the home where your pet plays? (required)
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If Yes, what kind:
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Are the room(s) where your pet lives / where cage is located air conditioned? (required)
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Are the room(s) where your pet lives / where cage is located heated? (required)
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What is the typical temperature? (required)
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Please tell us about anything else that is in your pet’s habitat:
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What packaged food does your pet eat? (Brand & Variety) (required)
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This food contains: (required)
Plain pellets
Colored/flavored pellets
Seeds
Nuts
Dried Fruit
Grains
Dried pasta
Dried Egg
Other
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What fresh foods (fruits, veggies, table scraps) does your pet eat? (required)
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How often are fresh foods fed? (required)
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How much fresh foods do you feed? (required)
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Do you give a vitamin supplement? (required)
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Are vitamins put in the pet’s water? (required)
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Does your pet have water available for bathing, and/or do you mist regularly? (required)
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When was your pet’s last molt? (required)
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Has your pet ever laid an egg? (required)
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If Yes, when:
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How many eggs:
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The eggs...
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Was breeding intentional?
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Please tell us about any history of behavioral problems (i.e. feather picking, biting, etc.):
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Patient Name: (required)
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Today's Date: (required)
:
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Appointment Date & Time (required)
:
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