Avian New Patient History Form

Is the patient an Aviary Bird Companion Bird Zoological Bird

Is the cage in which the bird was transported, the bird's permanent cage? Yes No

Where is the cage usually located in the home?

Is the bird able to remove itself from view? Yes No

Is the bird permitted to get adequate sleep at night? Yes No

How many hours of darkness does the bird get each day?

Does the bird have access to direct, unfiltered sunlight on a regular basis? Yes No

Does the bird come out of its cage? Yes No Does Not Apply

Are the bird's wings Clipped Free-Flighted

Is the bird exposed to potentially dangerous situations? Yes No

Does the bird interact with other animals or birds? Yes No

Is the bird subject to potential exposure to toxins? Yes No