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BIRD MEDICAL INTAKE FORM
Owner's Name:
Patient's Name:
Reason for Visit:
Additional Concerns:
Symptoms:
Duration of Symptoms:
Prior History of Medical Issues:
Puffed Up and/or in Bottom of Cage:
Behavioral Changes:
Eating/Drinking?
Urinating/Defecating?
Vomiting?
Current Diet Including Any Supplements:
What Type of Cage & Where is it Located?
What is the Substrate (what you line the bottom of the cage with) of the Cage?
Bathing: How? Frequency?
Hours of Sleep at Night?
Direct Sunlight Weekly that is NOT Filtered by a Window?
How did you Acquire the Bird?
How Long Have you Had the Bird?
Has s/he had a Negative Chlamydia Test?
How Many Other Animals in the Home?
Submit
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