If your bird is a new avian patient at Carolina Veterinary Specialists in Huntersville, please fill out our New Avian Patient form using one of the options below.

OPTION 1
Fill Out Online

Complete the online form below and submit.

OPTION 2
Print & Complete

Once completed, bring the form with you.

Download Form

OPTION 3
Complete in Office

If you prefer, you can fill out the form when you arrive at our hospital.

New Avian Patient Form

Please provide us with the following information.

Important: If your pet is an avian or exotic patient, please also download and complete the appropriate questionnaire.

First Name *

Last Name *

Phone *

Email *

What is the best way to reach you? *

How did you hear about us? *

If Vet Referral, Provide Name of Vet

If Other, Please Provide Details

About Your Pet

Bird's Name *

Species of Bird *

Sex (Gender) *

Method of Gender Determination

Do you know the date of hatch? *

Date of Hatch (If Known)

Date bird was Obtained *

Bird's Age When Obtained *

Place Bird was Obtained: *

Name of Pet Store, Breeder, or Rehoming Organization

Enclosure (Cage)

Enclosure Type *

Enclosure Material *

Details of Enclosure Material (if Other)

Brand of Cage *

Brand (if Other)

What are the enclosures dimensions? (Include Height, Width, and Depth) *

What kind of liner is in the enclosure?

Liner Details (if Other)

Is there a grate (wiring) at the bottom of the enclosure? *

Enclosure Location in Home *

Location Details (if Other)

Is your bird given time out of its enclosure? *

How many hours is your bird allowed out of its enclosure during each session?

Is the enclosure covered at night? *

Is your bird bathed? *

How is your bird bathed?

What do you use when bathing your pet?

If Other, What do you use when bathing your bird?

Enclosure Contents

Perches (Please Provide Details) *

Toys (Please Provide Details) *

Other Enrichment Items (Please Provide Details) *

Food Containers *

Details of Food Container (if Other)

Water Containers *

Details of Water Container (if Other)

Other Perches or Enclosures *

Details of Perches or Other Enclosures (if Other)

Diet

Foods Offered *

Pellets

Seeds and Nuts

Fruits (Please Provide Details Below)

Vegetables (Please Provide Details Below)

Breads, Whole Grains, Grains, Cereal (Please Provide Details Below)

Meat (Please Provide Details Below)

Dairy (Please Provide Details Below)

Other (Please Provide Details Below)

Foods Offered *

Provide details of foods offered to your bird. (ie: brands of commercial bird foods and types fresh foods such as fruits and dairy). *

Do you provide your bird suppliments? *

Details of Supplements (if Yes)

Environment

Are there any other birds in the home? *

Details of Other Birds (if Yes)

Are the other birds in your home healthy? Provide Details

Are there other pets in your home? *

Details of Other Pets in Your Home

Is your bird exposed to birds outside of the home? *

Details of Exposure to Outside Birds (if Yes)

Medical History

Has your bird had previous wellness exams? *

Details of Previous Wellness Exams, Medications, Adverse Drug Reactions, and Previous Health Concerns

Date of last polyomavirus vaccine (if ever)?

If your bird is female, has she ever laid eggs before?

Behavior

How would you describe your bird's personality? *

Details of Your Bird's Personality (if Other)

Any previous or current behavioral concerns? *

Details of Behavioral Concerns (if Yes)

Current Concerns

When did the current concern begin? Provide Approximate Date or 'Don't Know' *

Describe the Current Concern *

How has problem changed? *

Better

Worse

Episodic

Same

Unknown

If your bird is currently on medication or supplements, please provide details.

Other

Are there any special requests for handling your pet today?

Please describe any additional questions or concerns you may have regarding this bird.

Upload Files or Images

Please attach any previous medical records and files, or images of cage, home, food, droppings, pet, etc.

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Happy Tails from Clients

"I truly could not recommend CVS enough, from the moment we walked in the door with an emergency situation the compassion and care that both we and our hedgehog Hershey received was wonderful from every single staff member and doctor we encountered."
- Sarah H.

New Patient Form - Birds

OPTION 1
Fill Out Online

OPTION 2
Print & Complete

OPTION 3
Complete in Office

New Avian Patient Form

About Your Pet

Enclosure (Cage)

Enclosure Contents

Diet

Environment

Medical History

Behavior

Current Concerns

Other

Upload Files or Images

Caring for Pets in Huntersville

Important Information For Clients Regarding COVID-19 Virus. Click Here

New Patient Form - Birds

OPTION 1Fill Out Online

OPTION 2Print & Complete

OPTION 3Complete in Office

New Avian Patient Form

About Your Pet

Enclosure (Cage)

Enclosure Contents

Diet

Environment

Medical History

Behavior

Current Concerns

Other

Upload Files or Images

Caring for Pets in Huntersville

Important Information For Clients Regarding COVID-19 Virus. Click Here

OPTION 1
Fill Out Online

OPTION 2
Print & Complete

OPTION 3
Complete in Office