Avian Registration Form

Owner's Name *

Phone Number *

Email *

Pet's Name *

Birthday (approx.)

Date Acquired *

Species

Sex

Microchip #

Band

How was the sex identified?

Are the wing's trimmed?

Yes
No

Has the bird been dewormed?

Yes
No

Is this bird a pet?

Yes
No

Is this bird a breeding animal?

Yes
No

Has your bird been quarantined?

Yes
No

Was the bird isolated prior to introduction at present location?

Yes
No

How long has the bird been in current environment?

Type of housing

Any birds share the space?

Any other birds/pets in the house?

If there were other birds in the house, are any sick?

Yes
No

If there were other birds in the house, have any died?

Yes
No

Any changes in fecal colour or consistency?

What is used on cage bottom and perches?

Is it reachable?

Yes
No

Type of bird food

What brand of food?

If you feed your pet a combination diet, please describe

Any recent diet changes?

How is grit fed?

Any vitamins or supplements?

How is water offered?

What prompted this visit?

New Patients Are Always Welcome!