Avian History Form

Date

Name

First NameLast Name

Pet's Name:

Species and Breed (if known):

What is the primary reason for your visit and what concerns do you have today?

Has your pet received any treatment at home? What was given, and how long was it given?

Has your pet been seen at another clinic? If so, please list the clinic name so we can call for records.

The following questions are regarding the husbandry, or at home living environment for your pet. This information helps us get a full picture of what may be going on with your pet.

How old is your pet?

How long have you had your pet?

What type of food does your pet eat (pellets/seed/fruit/vegetables/other)? Please include brand for pellets/seed.

Where did you get your pet from?

Has your pet been DNA sexed?

Is your pet microchipped?

YesNo

What is your pet housed in (i.e. an aviary, free-roam, powder coated cage, etc.)?

Please email or upload pictures of your pet’s enclosure.

Browse Files

What is the size of your pet’s enclosure (L x H x W)?

Where in the house is your pet primarily living (i.e. living room, garage, bedroom)?

Is the enclosure near vents/windows/outside walls?

YesNo

How much time does your pet spend outside of the enclosure?

What kind of social interaction or training do you do with your bird?

What substrate (bedding) do you use in the enclosure?

How frequently do you spot clean and fully clean the enclosure?

How often do you clean the food and water dishes?

What do you use to clean the enclosure and dishes?

What kind of hides and enrichment are in the enclosure (i.e. toys, chews, blankets, hammocks, etc.)?

What do you primarily feed your pet (i.e. pellets, seeds, fruits/veggies, human food)? Please list brands if known.

If you feed human food, what kinds of human food do you feed?

How much and how often do you feed your pet?

What treats do you give your pet? How often?

Do you use vitamin or mineral supplements? If so, what kind and how often?

What is the maximum and minimum temperature in the enclosure?

How many hours of daylight and nighttime does your pet get each day?

Do you use a UVB light for your bird?

YesNo

Has your pet ever laid eggs before?

YesNo

Are there any nesting areas in the enclosure?

YesNo

Has your bird every received any hormone treatment in the past?

YesNo

Does your pet have any history of feather damaging/plucking behavior in the past?

YesNo

Are there any other pets in the house?

How often does this pet interact with the other pets?