Avian Pre-Appointment Questionnaire Name(Required) First Last Name of person attending appointment(Required) First Last Email(Required) Pet's Name(Required)Appointment Date(Required) MM slash DD slash YYYY Do you need an estimate for your appointment?(Required) Yes No If your pet has lab work, how would you like the results communicated to you?(Required) Text Message Email Phone Call How old is your bird?(Required)Date acquired(Required) MM slash DD slash YYYY Has patient been DNA sexed?(Required) Yes No Gender(Required) Male Female Gynandromorphic (Rare) Unsure Any vents or windows near the cage?(Required) Yes No Does the patient fly?(Required) Yes Yes, but wings are trimmed. No No, due to a medical issue. Who is the bird's main human?(Required)Is there a primary caretaker, or is it a shared responsibility?(Required) Primary caretaker is the bird's main person. Primary caretaker is someone other than the bird's main person. Caring for the bird is a shared responsibility. Who are the other people that the bird has access to or is around? How does the bird act with them in comparison to their main human?(Required)Please describe the bird's housing. Size of cage, items in the cage, and where it is located. Give as many details as possible.(Required)How many hours is the bird confined or is permitted to roam free? Does it vary from day to day? How large of an area is it allowed to roam in?(Required)Are there other animals in the home? How many and what kind?(Required)Where is the patient fed? Please describe the brand, any mixes or homemade food you feed. Do you provide supplements? Is the patient given any human foods? Please give as many details as possible.(Required)Enrichment: What does the bird do all day? Please give as many details as possible.(Required)Are there any current concerns? Please give details of when any issues started and a timeline of any development or behavior changes.(Required)If there are concerns, have there been any changes in the home environment around that time? (Furniture change, construction, new people, new scents or perfumes, etc?)I understand that I assume financial responsibility for all services rendered, and that payment is due on the date of the appointment. The individual bringing my pet to the appointment is authorized to request services and communicate what my pet needs.(Required)
