Forms - Avian Home Veterinary Care, PLLC

New patient form

I will give Dr. Grodio at least 24 hours notice should I need to cancel my scheduled appointment (but please see sickness policy at end of form). (required)

Name (first & last)(required)

Email(required)

Phone number (please note which is your cell number)(required)

Secondary phone number

Home address(required)

If you do not have a private driveway, comment on available parking

Pet's name(required)

Pet's species(required)

Sex(required)

Age(required)

Where did you buy/adopt/find your pet?(required)

How long have you owned pet?(required)

Where is pet's enclosure located in home?(required)

Does your pet have a cagemate(s)? If so, list species and sex, if known.(required)

Describe pet's enclosure (including approximate size, substrate/bedding if applicable, etc). Reptile owners: list heat and light sources.(required)

Diet (please be detailed about all food items offered)(required)

Health history (have previous medical records emailed to vet@avianhomevet.com)(required)

Are there other pets in the home? Please list species and breed, when applicable.(required)

Any other information you would like to provide?

How did you hear about us? e.g. Google search, Facebook, Valpak flyer (2021), postcard direct mailing (2020), found flyer in a store, referral from vet hospital, referral from a friend(required)

I understand that Avian Home Vet Care cannot visit COVID-quaratined homes. I will ask Dr. Grodio to reschedule the appointment if anyone in the household is showing symptoms of contagious disease (cold, flu, COVID).(required)