Exotics Avian History Form Your First and Last Name * First Name Last Name Email * Phone * (###) ### #### Pet's Name * First Name Last Name Breed * Pet's Age * Gender * Male Female Unknown How do you know the gender of your pet: * DNA Surgically Unsure Other Does your bird have any identification? * Microchip Tattoo Band None Where did you get your bird? * Breeder Pet Store Friend / Family Rescue Found Caught Was your pet quarantined: * Yes No If yes, how long and where: How is your bird kept? (Check all that apply) * Aviary Cage Free in House Coop Indoors Outdoors Separate Room Kept near Family What other birds live in the house? What toys does your bird love? * Bells Rope Toys Leather Toys Wood Toys Swings Ladders Mirrors Shreddables Plush Toys Other Handmade Purchased What type of perches does your bird have? * Natural Branches Plastic Metal Rope Sand Paper Stone None Other What is on the bottom of the cage? * Newspaper Corn Cob Kitty Litter Towels Paper Towels Tile Stone None Other Do you cover the cage at night? * Yes No If yes, how many hours of darkness? What does your bird eat? * Pellets Seeds & Nuts Vegetables Fruit Formula Table Scraps What pelleted diet do you feed? Do you give your bird any Vitamins or Supplements? If yes, please list below and the amount you give each day. If no, please put N/A. * How is water offered? How often do you change it? * Does your bird bathe? * Yes No If yes, how and how often? What tests have been done before? * Psittacosis PBFD (Beak and Feather Disease) Polyoma Fecal Analysis PDD New Castle's Disease Aspergillosis Avian Pox Other None or Unknown What has your bird been vaccinated against? Thank you for filling out our form. We appreciate the information ahead of time. We look forward to seeing you and your pet! ~Como Park Animal Hospital * 24 Hour Care~
