Does your pet ever go outside? (required) No Yes, supervised playtime Yes, unsupervised playtime (includes time in cage/fenced area, if no human present) Yes, lives outside in good weather Yes, lives outside all yearAre your pet’s wings kept clipped? (required) Yes NoDoes your pet live primarily in a cage? (required) Yes NoIf Yes, what are the dimensions of the cage? 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)? Where is the cage located? (required) Does your pet share a cage/habitat with any other pets? (required) Yes NoDoes your pet interact or live with other pets, outside of a cage (including supervised playtime)? (required) Yes NoWhat bedding / cage lining do you use in your pet’s habitat? (required) CareFresh, CelSorb, Yesterday’s News, or other paper/pulp bedding Aspen shavings or pellets Pine or Cedar shavings or pellets Paper/Sandpaper cage liner (product intended for this use) Plain paper / paper towel (no print) Newspaper / paper towel / scrap papers with print OtherIs your pet separated from bedding / cage liner by a grate? (required) Yes NoHow many perches are available in the cage? (required) Approximately how wide are perches? (Diameter) Widest: (required) Approximately how wide are perches? (Diameter) Narrowest: (required) How many perches are sandpaper or other rough texture? (required) Is there a nest box or other hiding spot in cage / living area? (required) Yes NoWhat sort of toys does your pet have? (required) Are there any live plants in your pet’s habitat, or in areas of the home where your pet plays? (required) Yes NoIf Yes, what kind: Are the room(s) where your pet lives / where cage is located air conditioned? (required) Yes NoAre the room(s) where your pet lives / where cage is located heated? (required) Yes NoWhat is the typical temperature? (required) Please tell us about anything else that is in your pet’s habitat: What packaged food does your pet eat? (Brand & Variety) (required) This food contains: (required) Plain pellets Colored/flavored pellets Seeds Nuts Dried Fruit Grains Dried pasta Dried Egg OtherWhat fresh foods (fruits, veggies, table scraps) does your pet eat? (required) How often are fresh foods fed? (required) How much fresh foods do you feed? (required) Do you give a vitamin supplement? (required) Yes NoAre vitamins put in the pet’s water? (required) Yes NoDoes your pet have water available for bathing, and/or do you mist regularly? (required) Yes NoWhen was your pet’s last molt? (required) Has your pet ever laid an egg? (required) Yes NoIf Yes, when: How many eggs: The eggs... hatched, produced live young did not hatch / were not fertileWas breeding intentional? Yes, intentional breeding No, accidental breeding No breeding possible – bird is housed alone or with other
femalesPlease tell us about any history of behavioral problems (i.e. feather picking, biting, etc.): Patient Name: (required) Today's Date: (required)
:
Appointment Date & Time (required)
: