Avian History FormPet NameAgeSpeciesBreedWild caught or captive bred?Sex Female Male UnknownConfirmed by Endoscopy DNA Sexing OtherBackground InformationLength of time ownedWhere acquired?Please select oneBreederPet storeRescueOther locationDoes your bird roam freely in the house? Yes NoHow many hours does your bird get outside the cage?Is your bird allowed outside? Yes NoIs yes, how often?Are there any other pets? Yes NoIf yes, please specify.Is your bird housed by itself? Yes NoIf no, please specify.HusbandryDescribe your enclosure, including size, type/material of cage, number of perches, toys, etc. PLEASE BRING PICTURESWhere in the house is the cage located?Is there a separate cage at night or is the cage covered at night?If covered, for how many hours at night?Is there any bedding material? Yes NoIf yes, please specify.How often is the cage cleaned?What type of disinfectant is used?Do you bathe/mist your bird? Yes NoIf yes, please specify.Any recent changes in housing? Yes NoIf yes, please specify.DietPlease list the items included in the diet, brand and amount/frequency fed.Are there any treats/table scraps offered? Yes NoIf yes, please specify.Are there any supplements used? Yes NoIf yes, please specify.How is water offered? Frequency changed?Have there been recent changes to diet? Yes NoIf yes, please specify.Owner InformationName*Secondary Owner?* Yes NoStreet Address*Address Line 2City*State/Province/Region*TextZip/Postal Code*Phone*Email*How did you hear about us?*Please select oneInternetYellow PagesSignAdPet StorePersonal ReferralPet ShowOtherHow did you hear about us?Referrer's Name:Vet HistoryPrevious Veterinarian or Veterinary ClinicDate of Most Recent Vet VisitXX/XX/20XXAny pre-existing conditions?Have you scheduled an appointment with us? * Yes (If yes, when is your appointment?) NoIf yes, when is your appointment?Submit Your Pet's InfoIf you are human, leave this field blank.