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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
Senior Wellness
Diagnostics
Preventative Medicine
Pet Boarding
Nutrition
Online Pharmacy
Emergency Care
Contact Us
Request an Appointment
(970) 241-9866
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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
Where?
Any prior medical concerns?
Do you have any medical records?
Is your pet on any medications?
If Your Bird is Female
Has she ever laid eggs?
When was the last clutch laid?
How many eggs are usually laid in a clutch?
Have any malformed or abnormally shelled eggs been produced?
Is your bird showing any broody behavior (ie. shredding paper, hiding in dark places, or regurgitating to a mirror, other birds, or the owner)?
Diet
Describe your bird's diet. What food items are actually consumed, & in what proportions?
*
Is your pet on a pellet or seed diet?
*
Yes
No
Brand?
Amount and frequency?
Veggies/fruits offered?
*
Yes
No
Types?
Amount and frequency?
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?
Grooming
Are your bird's wings clipped?
*
Yes
No
How often is it done?
Where?
Does your bird like to bathe or shower?
*
Yes
No
How often?
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
Is there any possible exposure to wild birds?
*
Yes
No
What kind of cage do they live in?
*
Where in the home is it located?
*
What is the cage size?
*
How many perches?
*
What are the perches made of?
*
What is the cage lined with?
*
How often is the cage cleaned?
*
What do you clean the cage with?
*
Is there a nest box?
*
Yes
No
Is the cage covered at night?
*
Yes
No
What time?
Enrichment
Does your pet spend time outside of their habitat?
*
Yes
No
How often and for how long?
Indoors or outdoors?
Are they ever allowed to roam unsupervised?
Does your pet have access to toys?
*
Yes
No
What kind?
How often are they changed/cleaned?
Does your pet interact with any other animals? What kind?
*
Is your pet routinely handled?
*
Yes
No
How much 'one-on-one' attention do they receive?
Who handles them?
Signature
*
Date
*
MM slash DD slash YYYY
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Email
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