Name: Macungie Animal Hospital
Address: 161 East Main St, Macungie, PA, 18062, US
Telephone: (610) 421-8381
Price range: $$

Avian History Form

Owner's Name*
First Last
Your Pet’s Information
Name*
Species Or Common Name
Date of Birth or Age (if known)*
Origin*
- Captive Bred
- Wild Caught
- Unknown
Sex*
Determined by?*
- DNA
- Visual
- Other
How long have you had your pet?
From where did you obtain your pet?
Do you have other pets or birds in the household?*
- Yes
- No
Have you or your bird had any contact with other birds in the last 30 days?*
- Yes
- No
When was the last bird added to your collection?
Cage Details
Where is the cage located?*
- Inside
- Outside
What are the dimensions of the cage and what is it made out of?*
What is in the cage set up (décor, toys, ventilation, etc)? Substrate?*
How often do you clean the cage and what do you clean it with?
What percentage of the time does your bird spend in the cage?
Is your bird supervised when out of the cage?
- Yes
- No
Are there are any smokers in the house?
- Yes
- No
Do you use aerosolized substances?
- Yes
- No
Does your bird have regular exposure to sunlight?
- Yes
- No
Does your bird have exposure to UVA and UVB lighting?
- Yes
- No
Does your bird have exposure to UVA and UVB lighting?
- Yes
- No
What is your bird’s day and night cycle (hours of sleep)?
Have there been any changes in the environment in the last 3 months?*
- Yes
- No
Diet Details
How often do you feed your bird?
Please indicate which foods are eaten and the approximate volume:*
Pellets, Seeds, Vegetables, Fruits, Meat Products, Treats/Others
Do you use any nutritional supplements in food or water?*
- Yes
- No
Water Details
What water supply do you provide?*
- City Tap Water
- Bottled Water
- Well Water
How is water provided?*
- Bowl
- Dripper System
How often is the water changed?*
Reason for Visit today
What is the primary reason why you brought your pet in to see veterinarian today?
Have you noticed any changes in feeding or drinking behavior?*
- Yes
- No
Have you noticed any changes in droppings?*
- Yes
- No
Have you noticed any changes in your bird’s behavior?*
- Yes
- No
Has your pet had any previous health problems OR reproductive problems?*
- Yes
- No
Have any other animals or people in your household had any illness within the last 30 days?*
- Yes
- No
What are your pet’s current medications? Has your pet received any medications or treatments in the last 3 months (what was used, dosage, how often and duration):

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Contact

161 East Main St.,
Macungie, PA 18062

(610) 421-8381
portal@macungieanimalhospital.com

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Hours

Monday & Thursday:
8:00 AM – 7:00 PM
Tuesday, Wednesday, Friday:
8:00 AM – 6:00 PM
Saturday:
8:00 AM – 2:00 PM

Avian History Form

Your Pet’s Information

Cage Details

Diet Details

Water Details