Owner Information

Name *

First

Last

Email *

Phone Number *

Pet Information

Avian Name or Identification *

Common or Scientific Species Name *

Date of Birth

Age *

Sex *

Sex Determined by *

Origin *

How long have you had this bird? *

From where did you obtain this bird? *

Does this bird have a reproductive history? *

Have you or your bird had any contact with other birds in the last 30 days? *

Do you have other birds or pets? *

When was the last bird added to your collection? *

Reason for Presentation Today

Reason for Presentation Today *

What health problems has your bird had previously? *

Has your bird received any treatment in the last 30 days? *

Have you noticed any change in your bird's behavior? *

Have any other animals or people in the household had any illness in the last 30 days? *

Diet

How often do you feed your animal? *

Indicate which foods are eaten and in what amounts (by number, weight, or approx. volume):

Do you use any water supplements? *

Have you noticed any changes in feeding or drinking behavior? Please give details: *

Have you noticed any changes in droppings (fecal material, urine, urates)? Please give details: *

Where is the cage located? Please specify whether it is inside or outside and provide details. *

What is the cage made of? *

Cage Size *

What kind of bedding is used? *

Are bathing/spraying facilities provided?

What décor and furnishings are present? (Such as nest box, perches, swings, toys, other. Please give details.) *

(copy) cage?

How often is the cage cleaned? *

What cleaning/disinfectant agents are used? *

What percentage of time does your bird spend inside and outside of its cage?

Inside % *

Outside % *

Is the animal supervised when out of the cage? (Please give details) *

Is your bird exposed to full-spectrum (UVA and UVB) lighting?

What is your bird's light/dark cycle? *

Does anyone in the household smoke?

Do you use any aerosolized products? *

Have there been changes in the bird's environment in the last 3 months? *

Clinic Policies

Twin Cities Veterinary Clinic

Appointment Policies

We require 24 hours’ notice for appointment changes. Our schedule is often full, so timely cancellations help us care for sick and injured pets. Missed, late, or last-minute cancellations may be charged a no-show fee. Late arrivals may need to reschedule. Any fees must be paid before future services.

Same-Day / Work-In / Emergency Visits

Same-day, work-in/walk-in, and emergency appointments may include additional fees and longer wait times. We are not a walk-in clinic and operate primarily by appointment.

Check-In & Arrival

New patients and those needing health certificates should check in 15-30 minutes early and provide prior medical records in advance. Dogs must be leashed; cats and small pets should be in carriers. Pets and children under 12 must be supervised at all times.

Sick Policy

If you have respiratory or flu-like symptoms or recent COVID-19 exposure, please notify us before your appointment. We may ask you to wait in your vehicle while we bring your pet inside. Masks are available on request, and staff can mask upon request.

Payment Policy

Payment is due at the time of service. We accept major credit cards, CareCredit, and cash. We do not offer payment plans. Please discuss financial limits with the veterinarian before treatment. More information is available on our Financial Assistance page on our website at twincitiesvet.com.

Prescription Refills

Please allow 24—48 hours for refill processing. You will be notified when medications are ready. Pets must be current on their annual exam for prescription authorization. We do not work directly with online pharmacies, but written prescriptions are available. Medications can be mailed for an additional fee.

Vaccinations

Patients must be up to date on required vaccines. Rabies vaccination is required by Alaska law. If you have concerns, speak with a veterinarian; medical exceptions may be discussed.

Zero-Tolerance Abuse Policy

We reserve the right to refuse service. Harassment, threats, abusive language, aggressive behavior, or actions that disrupt our staff, clients, or patients will not be tolerated. Clients may be asked to leave immediately, and law enforcement may be contacted if necessary.

Privacy Policy

We do not share personal information with third parties. Client and patient information is kept strictly confidential and is only released with the owner's consent.

Checkboxes *

I agree to the above policies.

Signature *

Clear Signature

Printed Name *

Date *

Avian History

Tell Us About Your Bird’s Health

Submit Your Avian History Form

Owner Information

Pet Information

Reason for Presentation Today

Diet

Clinic Policies

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Location

Contact Information

Hours