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Owner's Name
Today's Date
Phone
Email
Pet's Name
What species is your pet? (Please be specific – Blue & Gold Macaw, Yellow Naped Amazon, Zebra Finch, etc.)
How old is your pet? (provide hatch date if possible)
Sex
Male
Female
Unknown
How long have you had this pet?
Where was this pet acquired?
note
FEEDING
What does your pet eat? (Please be specific: primary diet, vitamin supplements, and treats.)
How often do you feed and/or change food?
Once
a
day
Twice
a
day
Free-Feed
/
Continuous
Other
Please specify:
How often is water changed?
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ENVIRONMENT / HOUSING
What kind of enclosure is your pet kept in?
Type of substrate: (ie: bedding, newspaper, etc)
How often is the substrate changed?
Type of Heat Source (if used):
Type of Light Source (if used):
Are there any other animals in the same cage?
note
MEDICAL ISSUES
Please list any past or current health problems:
Please list any specific concerns or questions you have about your pet's health or husbandry:
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