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.
First & Last Name of Pet Owner
Pet Bird's Name
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.
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
, 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
My Pet Has Been Surgically Sterilized
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?
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.
Time with People
Please describe the average amount of time your bird spends interacting with people per day/week etc.
Time out of Enclosure
Please describe the average amount of time your bird spends outside of his/her enclosure(s) per day/week etc.
Please select all of the true statments
My Bird's Wings Are Trimmed
My Bird's Nails are Trimmed
My Bird's Beak is Trimmed
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
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"
If your pet will need refills today please indicate how we can help:
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