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Home
Our Hospital
Our Doctors
AAHA-Accredited Practice
Links
Employment
Payment Options
PetDesk
Paisley Paws
New Clients
Pet Insurance
Forms
Services
Pet Wellness Exams
Vaccinations
Dental Care
Microchipping
Spay & Neuter
Surgery
Pain Management
Senior Wellness
Diagnostics
Preventative Medicine
Pet Boarding
Nutrition
Online Pharmacy
Emergency Care
Contact Us
(970) 241-9866
Make an Appointment
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Poultry New Patient Form
Poultry New Patient Form
"
*
" indicates required fields
Client Information
Name
*
First
Last
Phone
*
History
Pet's Name
*
Species
*
Age
*
Sex
*
Male
Female
Unknown
How do you know your bird's gender?
*
Where did you get your pet?
*
How long have you owned your pet?
*
Has your pet been to a vet before?
*
Yes
No
Has your bird had any vaccines? If yes, please list below:
Where?
Any prior medical concerns?
Do you have any medical records?
Is your pet on any medications?
If Your Bird is Female
Have any malformed or abnormally shelled eggs been produced?
Is your bird showing any broody behavior?
Diet
Describe your bird's diet. What food items are actually consumed, & in what proportions?
*
Other treats/foods?
*
Yes
No
Types?
Amount and frequency?
What water source is offered?
*
How often is it cleaned?
*
Any supplements, grit, or cuttlebone provided?
*
Yes
No
Type, amount, and frequency?
How is it provided?
Lifestyle and Habitat
Has your pet been exposed to any "new" birds recently?
*
Yes
No
This includes newly acquired birds AND bird taken out of the home for bird shows, grooming, boarding, etc
What kind of housing do they live in?
Free range
Coop w/ run
Signature
*
Date
*
MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.
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