Phone *
Email *
Pet's Name
Species:
Date of birth: *
Date acquired and source (pet store, breeder, previous owner):
Number of previous owners (other than breeder, store): *
What states and/or countries has your pet lived in?
If yes, please give details:
When was the last molt?
How often has this bird been molting?
If yes, please give details
If yes, please give details:
If yes, please give details
When was the last bird added to your collection?
Is the animal kept indoors or outdoors?
Describe the cage enclosure (size, type, objects in cage, furnishings, etc.):
What type of material is used to line the bottom of the cage/litter pan?
If yes, please give details
How often is the cage cleaned?
What is used to clean/disinfect?
What percentage of time does your bird spend out of the cage?
If yes, please give details:
Frequency and length of time
Brand
What is your bird’s light/dark cycle?
If yes, please describe
How often do you feed your bird? *
If yes, what, how much, and how often?
How often is the water provided?
How often is the water changed?
If your pet is here for an illness, please describe the signs/symptoms and how long your pet has been showing these signs/symptoms:
Has your pet had any previous conditions, operations, or problems (including dental or gastrointestinal problems)?
If yes, please list them
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