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Avian lifestyle Assessment

Please click the button below to fill out the form.

Avian lifestyle

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Avian Lifestyle Assessment

Please fill out the form as completely and as accurately as possible, thank you.

Name *

First

Last

Email *

Pet's Name *

Origin:

Wild Caught or Hand Raised?

Species

Who/where did you obtain the bird from?

Sex

Age

Length of Ownership

Reason we are seeing your pet today *

Duration of complaint *

Is it getting worse, improving or staying the same? *

Previous or current medications/vitamins & minerals *

Any prior health issues we should know about? *

Please list previous vaccinations and diagnostics work as well as when they were given *

List seed brand/type, amount and frequency fed if provided

List pellet brand/type, amount and frequency fed if provided

List cooked foods brand/type, amount and frequency fed if provided

Example: Bird Street Bistro

List fruit brand/type, amount and frequency fed if provided

Example: Bird Street Bistro

List veggies brand/type, amount and frequency fed if provided

Example: Bird Street Bistro

List table food brand/type, amount and frequency fed if provided

Example: Bird Street Bistro

List treats brand/type, amount and frequency fed if provided)

Example: Bird Street Bistro

List supplements brand/type, amount and frequency fed if provided) (copy)

Example: Bird Street Bistro

Changes in appetite?

Yes- increased
Yes- decreased
No

Please list any recent diet changes and when they occured:

Any regurgitation?

Yes
No

Do droppings appear normal in color and amount produced?

Yes
No

Attitude/Personality normal?

Yes
No

Voice quality normal?

Yes
No

Cage Type

Chrome
Galvanized
Painted
Wood
Soldered

Floor type, substrate on floor and toys inside cage

Please list any other birds and their species:

Which of these do you use?

Nonstick pans
Paints
Adhesives
Pesticide spray
Household cleaners
Wood burning stove
Candles or incense

Does anyone in your household smoke?

Yes
No

Please list any unusual or odd behavior:

Last time services were done

Example: Nail trim, Wing trim or Beak trim

What services would you like to get done today, if any?

Ready to see us?

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At Loving Family Animal Hospital, we treat your pets with compassion and build lasting relationships with our clients. Easily request an appointment for your pet online and keep up with your pet’s health by downloading our app!

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Have a question?

Feel free to contact us! Complete our online form, and a member of our team will be in touch shortly.

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Address

14605 E. Arapahoe Rd. Unit H.
Aurora, CO 80016



Contact Info

E: info@lovingfamilyanimalhospital.com
P: 303-680-5050
F: 303-680-5550



Hours

M, W, F: 8 am – 6 pm
Tues, Thurs: 8 am – 8 pm
Sat: 9 am – 1 pm
Sun: Closed

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Last

Email *

Phone

How can we help you? *

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