Avian and Exotic Check-In Form - Elmwood Veterinary Hospital

CONTACT US506-858-9900
After-Hours506-387-4015

CLIENT & PET INFORMATION

Owner's Full Name *

Phone Number *

Email *

Pet's Name *

Birthday *

Sex *

Species *

Breed *

Acquired from? *

Date Acquired *

DIET

Food Type *

Amount Per Feeding *

Frequency *

Water Dispenser *

How often is the water changed? *

Supplements *

Hay/Pellet/Other: *

Date/Time of Last Meal *

Other Diet Notes:

HUSBANDRY

Cage Type *

Cage Size *

Cage Substrate *

Duration of Use *

Enrichment Products *

Ventilation *

Heating Equipment/Wattage *

Thermostat Setting *

Preferred Optimal Temperature Zone *

Yes
No

Highest Temp *

Lowest Temp *

Basking *

Yes
No

UV Lamp Types

Yes
No

How many hours per day are lights on?

Access to Wet/Dry Area *

Method of Humidity *

Cleaning Agents Used *

Frequency *

Last Changed *

Bathing *

Chewing Material *

Scratching Material *

Other Husbandry Notes:

Client observations/Reason for visit:

Security Question *

I HAVE READ AND UNDERSTOOD THE PRIVACY POLICY *