Health Risk Assessment - Avian
Hello! Please help us expedite your check-in process, decrease your wait time, and offer you the best medical care during your Preventative Healthcare Plan Exam, Annual Examination, or Complete Physical Exam, by completing this history form prior to your appointment. You can complete it by yourself, with other family members or in the office, but with a little advance planning we can help lead your attending DVM to develop the best plan for your pet's ongoing healthcare.
Email address *
First & Last Name of Pet Owner *
Your answer
Pet Bird's Name *
Your answer
Updated Contact Information
If you have moved within the last year, or if your phone number or primary email address has changed, please let us know so we can update your records.
Your answer
Does Your Pet Have A Photo On File? *
If you know your pet's photo has been updated, please select "Yes." If you would like to submit a new photo, please send your photo online to office@highlandvet.net, or we we'll be happy to take a picture with a fresh look for your on the day of your appointment.
This Bird's Gender Has Been Determined By *
What is your pet bird's gender *
How did you obtain your pet bird?
Length of Relationship With Your Bird?
How long have you known the bird, and how long have you owned him/her?
Your answer
This Bird's Primary "Person" *
Who is the person, or who are the people who primarily interact and handle this particular pet bird? Please indicate if any of these persons listed are under the age of 18.
Your answer
Time with People *
Please describe the average amount of time your bird spends interacting with people per day/week etc.
Your answer
Time out of Enclosure *
Please describe the average amount of time your bird spends outside of his/her enclosure(s) per day/week etc.
Your answer
Grooming
Please select all of the true statments
Grooming II
Please state when any of the last services occurred and your preferences for these services. What do you think is best for your bird with regard to grooming
Your answer
Current Medications *
If your pet is taking any prescription medications, please list the type and dosage below. For example, if your pet receives meloxicam liquid, you might type "Loxicam 1.5mg/ml - dosage on file." If your pet was prescribed medication previously, but no longer takes the medication, or if the dosage has been adjusted by a veterinarian or at home, you may comment below as well. If your pet takes no medications, simply comment "None" or "N/A"
Your answer
Refills Needed? *
If your pet will need refills today please indicate how we can help:
Your answer
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