Avian and Exotic Questionnaire "*" indicates required fields Patient Name*Species*Sex* M F Unknown If known, how was it determined?Is your pet spayed (female) or neutered (male)? Yes No Unknown Origin of pet? Wild caught Breeder Pet store Length of ownershipEnvironmentCageSize of cageWhere is the enclosure housed?% of day confined to enclosure/free roaming?How often is the cage/water cleaned?What is used to clean the cage?What substrate/bedding is used in the enclosure?Enclosure humidity (if applicable)What is the relative humidity of the enclosureHow is the humidity determinedEnclosure temperature (if applicable)What is the temperature gradient of the enclosure? Day:What is the temperature gradient of the enclosure? Night:How is the temperature measured?What type of heat source is utilized?Exposure to lightBrand of lighting:Amount of exposure to each dailyWhen was UVB bulb last changed (if applicable)Type of light (circle those that apply): Natural Fluorescent UVB Other Other Type of LightBathing habitsHow often is pet bathed?What is used to bathe pet?Other access/environments (play perches, floor, tables, outside, vacation home, etc.)Are you aware of an exposure your pet may have had to the following (Please circle all that apply)? Teflon Cook Wear Smoke Strong Cleaning Agents Aerosols Other Other type of exposureDiet:What food (including brand) is the pet provided? Please list all foods offered. List percentage of each category, if possible (i.e. %pellets, %seed, %vegetables, %fruit, %prey items)?What are the most consumed of these foods?How are non-commercial foods prepared (raw, cooked, etc.) ?Access to fresh waterHow frequently is water offered?How frequently are water bowls cleaned?If applicable, does pet have adequate space/water for soaking?
