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Open: 24 Hours
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(480) 945-8484
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Cat & Kitten Veterinary Care
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Cat End of Life Care
Cat Kidney Disease
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Hyperthyroidism
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Dog Behavior
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Dog Cardiology
Dog Dental Care
Dog Dermatology
Dog Deworming
Dog Diagnostic Imaging
Dog Emergency Care
Dog Endoscopy
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Dog Eye Care
Dog Fleas and Ticks
Dog Grooming
Dog Heartworm Disease
Dog Integrative Medicine
Dog Lab Work
Dog Laser Therapy
Dog Medical Boarding
Dog Medications
Dog Microchipping
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Client Avian Questionnaire
Please fill out as much as possible to help us evaluate your bird
Name
Contact Email
General Information
How long have you owned this bird?
Age, if known
Sex, if known
If sexed, was it by blood or feather?
Where did you get your bird?
Choose one
Imported
Captive-Bred
Unknown
How often is your bird misted/bathed?
Have you owned birds before?
Yes
No
If so, what type and when?
Vaccination history (type and date, if applicable)
Date of your bird’s last molt
Has your bird ever laid an egg?
If so, how many, how often, when?
Diet
Choose One
Bottled Water
Tap Water
Purified Water
What do you feed your bird?
Is seed stored in the freezer?
Diet breakdown
% seed
% pellets
% human food
Does your bird eat high fat treats?
Yes
No
If so, what and how much?
Does your bird eat sunflower seeds or peanuts?
Yes
No
If so, where are they purchased?
Environment
Does anyone in your house smoke?
Yes
No
Where?
Describe your cage: (Size, type of metal/paint, etc)
Type of toys
How often are they changed?
Where is the cage located?
Is the cage covered at night?
Are there any other birds in the home?
Yes
No
Are they in the same cage or different cages?
Medical History
Do fecal droppings/urates look abnormal?
Yes
No
Explain
Have you noticed any coughing/sneezing?
Yes
No
How often?
Have you noticed any weight loss or change in appetite?
Have you noticed any vomiting/regurgitation?
Have you noticed a change in activity level?
Have you noticed a change in tone of voice?
Does your bird feather pick?
Yes
No
How long/When did you first notice?
Has your bird been on any medications in the past month (prescribed or OTC)?
Yes
No
If so, names and dosages
Has your bird been sick before?
Yes
No
If so, when?
How was it treated?
Any other problems?
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