Name: Niles Animal Hospital & Bird Medical Center
Address: 7278 North Milwaukee, Niles, IL, 60714, US
Telephone: 847-647-8498
Price range: $$

Avian History Form

We would love to hear from you! Please fill out this form and we will get in touch with you shortly.

Step 1 of 6

Source of Bird
- Store
- Private Party
- Breeder
- Other
If other, please state:
Date acquired
Date Format: MM slash DD slash YYYY
- Wild Caught
- Domestic Bred
Has the bird been quarantined?
- Commercial
- Private
- Length of Time
State length of time
Was the bird isolated prior to introduction to present location?
Length of isolation (days)
Other bird species in isolation area
If known, any bird deaths during isolation period?

Diet
- Pelleted Food Only
- Seed
- Table Food
- Combination
Please suppy names of above chosen foods
Amount offered each day
Amount eaten each day
How is water offered?
- Cup
- Tube
Recently added foods or dietary changes

Tests
Vaccines the bird has been given and date given
Has the bird been seen by another veterinarian? When? Why?
Is the bird currently on medication?
Has the bird been on medication? When?
Which medications had been used?
Additional Comments:

Visit Us Today!

7278 North Milwaukee
Niles, IL, 60714

Call/Text: 847-647-9325

Fax: 847-647-8498
Email: info@nilesanimalhospital.com

Book an Appointment

Get Directions

Hours

Monday: 8:00am-12:00pm & 2:00pm-6:00pm
Tuesday: 8:00am-12:00pm & 2:00pm-6:00pm
Wednesday: 8:00am – 4:00pm
Thursday: 8:00am-12:00pm & 2:00pm-6:00pm
Friday: 8:00am-12:00pm & 2:00pm-6:00pm
Saturday: 8:00am – 4:00pm
Sunday: Closed

*CLOSED EVERY OTHER WEDNESDAY AND EVERY OTHER SATURDAY*

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Avian History Form

Step 1 of 6

Personal

Source of Bird

Present Environment

Diet

This Visit

Tests

Visit Us Today!

Call/Text: 847-647-9325

Hours