Owner's Information
Owner's Name (required) Owner's Phone Number (required) Owner's Email (recommended) Pet's Information Pet's Name (required) Pet's Breed (required) Pet's Sex (required) Pet's Age (required) Background Information Length of Time Owned: (required) Where was the bird acquired? (required) BreederPet StoreOther How often is the bird handled? (required) DailyOccasionallyNever Is Bird taken outside? (required) YesNo Fecal Characteristics (required) Vaccine History (required) Last Molt (required) Husbandry Is the animal housed indoors or outdoors? (required) IndoorsOutdoors Allowed to roam free in the house? (required) YesNo Where is the cage located?(required) Size of cage (required) Type of cage (required) Galvanized: (required) YesNo Cage Substrate: (required) How often is the cage cleaned? (required) What type of disinfectant is used to clean the cage? (required) Types of Toys/perches offered: (required) Nutrition Information Type of Food (required) Seed? (required) YesNo If yes, please specify the brand, frequency, and amount. Pellets? (required) YesNo If yes, please specify the brand, frequency, and amount. Fruits? (required) YesNo If yes, please specify the brand, frequency, and amount. Vegetables? (required) YesNo If yes, please specify the brand, frequency, and amount. Supplement/Treats Offered and Frequency (required) Water source (required) How often is the water changed? (required) Any other pets? (required) YesNo If yes, please specify. Other birds in house? (required) YesNo If yes, please specify. Are birds housed together? YesNo If not housed together, where are other animals located? Any new additions to the bird population? (required) YesNo If yes, please specify. Past medical history/problems Current presenting problems
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