EMERGENCY
| 780-570-9999
Submit a Referral
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Menu
Home
About
About Pulse
Careers
Contact
Departments
Avian and Exotics
Cardiology
Dentistry & Oral Surgery
Diagnostic Imaging
Emergency and Critical Care
Internal Medicine
Neurology
Ophthalmology
Surgery
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?
*
