Avian History Form - Mobile Veterinary Services for Birds and Fish

Mobile Veterinary Services for Birds and Fish

PO Box 1274
Taylors, SC, SC 29687

(864)483-9940

birddoctor.net

Services only in the Greenville County, SC area.

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.

New Avian History Form Form

Name

First Name	Last Name

E-Mail Address :

Vaccination history (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 and age of bird when acquired (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)

Text Block

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

Any previous treatment in last 30 days - list medications and diagnostics (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?)

Phone
Phone Type	Phone Number

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Mobile Veterinary Services

Birds & Fish
PO Box 1274
Taylors, SC 29687
(864)483-9940
(does not receive text messages)

New Client Form

Avian History Form

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