* Indicates required fields
* Your Name:
* Email Address:
* Phone Number:
* Address:
* City:
* State:
* Zip Code:
* How many people live in your household?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16+
* What other types of pets live in your house hold?
* Bird's Name:
Bird's Age (years):
Bird Type/Breed:
* How long have you owned the bird?
* Are you the first owner?
No
Yes
If not please give a brief history of what is known of previous homes.
* What diet is your bird on? Please give as many details as possible.
* Give us a description of what the daily routine for your bird is. Please include as many details as possible, including weekends.
* Have there been any changes to your routine?
* How many hours of uninterrupted sleep is your bird getting?
1
2
3
4
5
6
7
8
9
10
11
12+
* Give us a description of the lay out of your birds environment, with locations of cages and playpens.
* Give us a detailed description of the behavioral difficulties you are having.