Poultry Pre-Visit Form - Exotic Vet Care

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This field is for validation purposes and should be left unchanged.

(This form helps us to get a better understanding of how your bird is cared for at home and must be filled PRIOR TO the appointment)

Name(Required)

Prefix First Last Suffix

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

What is your bird's name?(Required)

What is the birth date or estimated age of your bird?(Required)

Gender?(Required)

Male

Female

Unsure

Prior vet/clinic information(Required)

What are the symptoms of concern for your pet and when did you first notice?(Required)

Have you done any home remedies or treatments for your concerns? If so, please list what and how often you've done this.(Required)

Has your bird had any previous medical concerns?(Required)

Is your bird on any current medications? If so please list what medications they are on.(Required)

How long have you had your bird and where did you get it from?(Required)

Has your bird been vaccinated? If so, what for? This is normally completed either when they are still in the egg or when they are a day old.(Required)

Is your bird microchipped?(Required)

Yes

Is your bird regularly dewormed/product?(Required)

What do you feed them? Please list daily amounts of each food and list any supplements you are using.(Required)

If your bird is a female is she laying eggs? If so, how many and how often?(Required)

Please describe where your bird lives (coop size and location) and where they spend most of their day.(Required)

Do you keep any other types of birds or other animals in the same coop or area? I.e. chickens, turkeys, rabbits, geese, ducks etc.(Required)

Yes

Lastly, how did you first hear about Exotic Vet Care?(Required)

Google (or other search engine)

Social media (Facebook, Instagram, YouTube etc)

Recommended by a friend or colleague

I saw the clinic from the street

Other