Mobile Poultry Service Request

This request form is for new poultry owners/farms, not existing NC State University clients.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Flock Size(Required)

Total number of birds (add all the birds you have, even if they are multiple species, e.g. chickens, turkeys, ducks)

Species(Required)

What poultry species are in your flock? (select all that apply)

Chickens

Turkeys

Ducks

Other

Indicate Species

Reason for the call?(Required)

In a few words describe the major concern or problem. Why would you like we visit (i.e. health check, respiratory signs, foot problems)

Age of poultry you are calling about(Required)

Please indicate whether the age is in days, weeks, months or years

Any clinical signs?(Required)

How long has the bird(s) been sick?(Required)

How much experience do you have with poultry?

Other information you consider important

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