Creature Comforts Animal Hospital- Avian History Form
Please complete this form to help expedite your appointment
Sign in to Google to save your progress. Learn more
Your Full Name *
My pets name is *
Are you the primary owner bringing the patient in or will someone else be bringing in for you? ( As a reminder all avian patients need to come in an appropriate carrier or container for their size) *
My appointment is on
MM
/
DD
/
YYYY
At this time
Time
:
My pet is coming in for... *
If not feeling well, please describe what is going on.
How long have you known this pet?
Where does your pet live in your home? *
Are their any other birds in the house? *
Other birds in the home...
How is your pet's appetite?
Clear selection
What types of food does your pet eat? List all please (Pellets, seed, fruit) *
How is your pet's drinking? *
Do you use and humidifier or air purifier? *
Does your pet have a normal droppings?
What is your pet's activity level?
Clear selection
Has your pet's weight changed?
Clear selection
Are you happy with your birds behavior?
If your pet is itching or scratching, where?
Is your pet limping or have any difficulty perching?
Do you find your bird preening (grooming) well?
Clear selection
Do you use any air fresheners, incense, candles?
Clear selection
Do you use any non-stick kitchen ware or a self cleaning oven?
Clear selection
Is your pet on any medications and what dosages?
Has your bird ever laid any eggs?
Clear selection
Do you usually have your pet`s wings clipped?
Clear selection
For your pet's safety we require they arrive to our office in a secure carrier. *
Required
Due to the Coronavirus Pandemic we are still seeing appointments in a concierge style. Our lobby is closed. Please bring your cell phone for easy communication and call the office when you arrive.  You will need to wait in the parking lot for the duration of your pet's appointment until payment is taken. It is important to wait in your vehicle, please be allow for a slightly longer appointment time as our current pandemic procedures require some additional steps. We thank you for your understanding as we do all we can to keep our patients and their people healthy. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms