Pocket Pet and Bird Intake Form

Gender(Required)

Male

Female

Unknown

Is the animal kept indoors or outdoors?(Required)

Indoors

Outdoors

Combination

Is the animal kept in a cage with other animals?(Required)

Yes

No

Is your pet supervised when it is out of the cage?

At all times

Sometimes

Not supervised

Is your pet here for a well pet check-up or is it sick?(Required)

Well Pet

Sick Pet

Is your pet's activity level(Required)

Normal

Decreased

Increased

Is your pet's appetite(Required)

Normal

Decreased

Increased

Have you noticed any of the following

Weight Loss

Weight Gain

Discharge from the eyes or nose

Increased breathing rate or efforce

Change in the droppings

An increased or decreased thirst

Weakness

Is there anything else that you would like done for your pet today?

Nail Trim

Ear Cleaning

Mat Trimming