Pre-Visit Survey for Birds Fill out this questionnaire before each preventive care visit to help us be as thorough as possible during your appointment.Bird's Name Your Name First Last Preferred E-mail Preferred Phone Number Is this number a cell phone? required Yes No Which method(s) of communication do you prefer? Text Messaging Phone Call E-mail What species is your bird? What is your bird's date of birth? (if unknown leave blank) MM slash DD slash YYYY How old is your bird? (list unknown if unsure) How long has your bird been in your possession? What sex is your bird? Male Female Unsure Sex confirmed by: certificate of DNA test history of egg laying certificate of surgical sexing appearance/coloring Where was the bird obtained? another owner breeder pet store bird rescue/shelter Other Specify What foods are being offered? Which foods/how much are being consumed? What treats are being offered? Are vitamins and supplements administered? If so, please explain. Are there any other birds in the home? Yes No Please describe the permanent cage.Where is the cage located in the house? How much dark and quiet sleep time is permitted most nights? Does he/she have access to direct, unfiltered sunlight on a regular basis? Please explain.If the bird spends time outside, is he/she safe from predators and diseases? How much time does he/she spend outside of the cage most days? Are flight feathers trimmed or is your bird able to fly? Does your bird interact with other pets or their food/water dishes? Is your bird potentially exposed to: non-stick cooking pans? cigarette/incense/candle smoke? aerosol sprays? household plants? Who is the primary caretaker? Other regions may have a higher risk for certain diseases that may be preventable (i.e. lyme disease or canine influenza).Whom does your bird seem to prefer? Does your bird dislike anyone? Is this causing problems?How many hours per day is your bird alone? What is your bird able to do, see, and hear while alone? Are you satisfied with how tame your bird is? Are there any frustrating behavior issues you’d like to address? Was your bird hand-reared or parent-reared? hand-reared parent-reared unknown We look forward to seeing you and your bird at your upcoming appointment. Thank you for entrusting us with your bird’s care!
