Mobile Veterinary Services for Birds and Fish

PO Box 1274
Taylors, SC, SC 29687

(864)483-9940

birddoctor.net

Please fill out this form before your appointment if you have pet or aviary birds; poultry or waterfowl. Thank you for your cooperation. Having this information in our electronic medical record before the visit will be very helpful. If you have made an appointment please also fill out the New Client form. Please Note! Filling out the history form alone without also filling out the New Client form means no appointment can be scheduled nor do we have any contact information on the history form that allows us to reply back by phone or email.

New Avian History Form Form

Name (required)
First Name (required)
Last Name (required)
Avian Name(s) or ID - you can list multiple (required)

Common name (species) - you can list multiple in the same order as avian names or ID (required)

Hatch Dates - you can add multiple dates in same order as above. (required)

Gender (sex) M or F or Unknown, determined by DNA endscopy, visual or other. (required)

Bird Contact with other bird in last 30 days. (required)

What is your main concern and what have you noticed (required)

Any previous health problems with the bird or birds. (required)

Any previous treatment in last 30 days - list medications and disagnostics (test) performed (required)

Any behavior changes?

Diet - please list diet items fed, by percentages of what the bird(s) actually consumed not offered. (required)

Water - how often changed

Any changes in droppings? (required)

Cage/aviary, coop location? (required)

Any type of bedding used? (required)

Poultry/Waterfowl owners please describe the size of ground/pond area.

Poultry/Waterfowl owners please note any problems with predators and your solutions.

Poultry/Waterfowl owners - are you a producer (do you sell birds or eggs for food consumption?)


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Mobile Veterinary Services

Birds & Fish
PO Box 1274
Taylors, SC 29687
(864)483-9940