For our Records
Owner Name
Select all that characterize your bird's personality:
Please select any current symptoms
Have you requested records to be sent to us?
Is your bird vaccinated?
Bird’s Behavior
Screaming
Biting
Is bird kept flighted?
Egg laying/hormonal behaviors/regurgitation?
Feather chewing or plucking?
Bonded to one person?
Does bird forage for food or treats?
Does bird play with toys?
Mutilation of skin/feet?
STATEMENT OF FINANCIAL RESPONSIBILITY

I am aware that I am responsible for all charges related to medical services that my pet receives at Brook-Falls Veterinary Hospital & Exotic Care. I understand that I will be asked to leave a deposit for medical services should my pet require a hospital stay. I understand that I must pay in full at the time medical services are completed. I have been advised that any charges revealed during post care audits will be invoiced in a timely manner and remain my financial responsibility.

Name
FEATHER PICKING HISTORY