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| 780-570-9999
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Menu
Home
About Us
Contact
Departments
Cardiology
Dentistry & Oral Surgery
Ophthalmology
Diagnostic Imaging
Surgery
Neurology
Avian and Exotics
Pet Owners
What To Expect
Referral Process
Pet Admission Forms
FAQ
Orthopedic Foundation for Animals (OFA)
Veterinarians
Submit a Referral
Continued Education
Testimonials
EMERGENCY
| 780-570-9999
Submit a Referral
Avian Questionnaire
Avian Questionnaire
Step
1
of
3
33%
Date
*
MM slash DD slash YYYY
Client Information
Last Name
*
Primary Phone Number
*
Email Address
*
Patient Information
Pet Name
*
Date of Birth
*
MM slash DD slash YYYY
Breed
Gender
*
F
FS
M
MN
Presenting Complaint?
*
Sexed – DNA tested or egg laying?
*
Last clutch – when laid / number of eggs / viable?
Where did you obtain your bird, how long ago?
*
Any previous medical history/surgeries?
*
Yes
No
List previous medical history/surgeries:
*
Is your bird on any medications/supplements?
*
Yes
No
List medications/supplements:
*
Is your bird in contact with other birds or animals?
*
Yes
No
List other birds or animals:
*
Does your bird travel/go to parrot shows?
*
Yes
No
Any new birds in the home?
*
Yes
No
What is your birds cage made of/size?
*
Where in the house is cage located?
*
Near windows, speakers, in separate room
Any scented products near cage or in house?
*
Scented candles, Febreze, scented cleaning products, bleach, Teflon, self-cleaning ovens, smoking
Is there any toys in the cage?
*
Yes
No
List of toys in the cage:
*
What is on the floor of the cage?
*
Paper
Corn cob
Gravel
How often is your bird out of the cage? Do they free roam (supervised)? Fly?
*
What do you feed your bird and how often/how much?
*
Main diet, every day, treats
How would you describe droppings/any change?
*
Last molt?
*
Any changes in behaviour?
*
Favourite person in the home?
*
