5201 Virginia Beach Blvd.
Virginia Beach, VA 23462
(757) 473-0111
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CLIENT FORMS
AVIAN HISTORY FORM
INTERNATIONAL HEALTH CERTIFICATE
NEW CLIENT / NEW PATIENT FORM
PET CARE VETERINARY HOSPITAL FINANCIAL POLICY
PRE-VISIT HISTORY QUESTIONNAIRE
REPTILE HISTORY FORM
VIRGINIA VETERINARY DISCLOSURE FORM
FEAR FREE FORMS
AVIAN FEAR FREE PRE-VISIT QUESTIONNAIRE
FEAR FREE PRE-VISIT QUESTIONNAIRE
PET MEMORIALS
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BACK TO WEBSITE
CLIENT FORMS
AVIAN HISTORY FORM
INTERNATIONAL HEALTH CERTIFICATE
NEW CLIENT / NEW PATIENT FORM
PET CARE VETERINARY HOSPITAL FINANCIAL POLICY
PRE-VISIT HISTORY QUESTIONNAIRE
REPTILE HISTORY FORM
VIRGINIA VETERINARY DISCLOSURE FORM
FEAR FREE FORMS
AVIAN FEAR FREE PRE-VISIT QUESTIONNAIRE
FEAR FREE PRE-VISIT QUESTIONNAIRE
PET MEMORIALS
Avian Fear Free Pre-Visit Questionnaire
Download the .pdf file
All Required Fields are marked (Required)
Client Name:
(Required)
First
Last
Date:
(Required)
MM slash DD slash YYYY
Client Email:
(Required)
Bird's Name:
(Required)
As Fear Free Certified Professionals, we want to make your bird’s veterinary experience as enjoyable and as stress-free as possible. As such, it’s important for us to understand what your bird might find upsetting. The information will help us to adjust our care to better serve and comfort your bird. Please answer the following questions to the best of your ability so we can take into consideration both your and your bird's preferences.
Does your bird show any reluctance to getting in the carrier?
Yes
No
During travel to the veterinary hospital, does your bird do any of the following:
(Required)
Eyes wide open
Freezing in place
Increased respiration
Chewing toes
Defecating
Trying to fly away/escape
Feathers slicked tight
Darting looks
Vocalizing
Eye pinning
Crouching/ Quivering wings
Feather loss
Other
If "Other" above, Please explain:
(Required)
Does your bird prefer:
(Required)
Female veterinarian
Male veterinarian
It doesn't matter
Check any situations listed below that your bird has shown avoidance or dislike of in the past. You can add additional comments at the end.
(Required)
Getting in their carrier or the car
Entering the veterinary hospital
Other pets and/or people passing by while in reception
Waiting with other people and animals in the waiting area
Being approached by veterinary staff
Getting on the scale for a weight
Hearing the doorbell, overhead intercom, or phones ringing
Sounds coming from the back areas of the practice
Going into the exam room
Being examined
Having direct eye contact with the technician and/or veterinarian
Loud voices during examination
Being taken out of the carrier
The use of instruments such as the stethoscope
Being taken out of the exam room for procedures
How would you describe your bird around other animals and people?
(Required)
Does your bird have any sensitive areas that s/he does not like to have touched by you or others?
(Required)
Are there any procedures your bird has not liked having performed at the veterinary hospital in the past or that seemed difficult for you or the staff to do? (weight, temperature, exam, blood draw) If so, how did your bird react?
(Required)
What are your bird’s favorite treats? (Please bring some to your next visit to our hospital):
(Required)
Does your bird like to play with toys? If so, what kinds?
(Required)
Has your bird ever been prescribed any supplements or medications to help with a visit to the veterinary hospital? If so, what was it and what sort of results did you experience?
(Required)
Anything else you would like us to know?
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