Avian History Form

Avian History Form
- Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Name
- Species
- Sex
- Age
- Color/Markings
- How often is your bird handled?
  
  DailyOccasionallyNever
- Do you have other birds?
  
  Yes, shared cageNoYes, separate cage
- Other birds in shared cage
- Please list any other pets in the household
  2 dogs, 1 cat, 2 chinchillas, etc.
- Where did you get your bird?
  breeder, pet store, etc.
- How long have you had your bird?
- Any new additions to your bird collection?
  
  YesNo
- New additions:
  species, when they were added, etc.
- Do you have behavioral concerns about your bird?
  
  YesNo
- Brief description of concerns:
  list concerns, timeline, etc.
- Fecal Consistency
- How often is your bird molting?
- When was last molt?
- Can your bird fly?
  
  YesNo
- Does your bird get wing trims?
  
  YesNo
- How often? When was last trim?
- Is your bird vaccinated?
  
  YesNo
- What vaccines were given and when?
- Does your bird have a reproductive history (i.e. egg laying, mating, etc.)?
  
  YesNo
- Please explain your bird's reproductive history
- Does your bird have any past medical history?
  illnesses, vet visits, chronic symptoms, etc. If seen by another vet, please provide name and phone number.
- Where is cage located?
- What is cage made of?
- Cage Size
- Bedding Used
- Please describe toys, perches, etc.
- What percentage of time does your bird spend in each of the following?
- What is your bird's light/dark cycle?
- What type of bathing or spraying is offered? How often?
  bath dish always available, shower weekly, mist with spray bottle every few days, etc.
- How often is the cage cleaned?
  spot clean daily, deep clean weekly, etc.
- What is used to clean the cage?
  wipes, water only, enzyme cleaner, etc.
- Supervised when outside of cage?
  
  YesNo
- Does anyone in your household smoke?
  
  YesNo
- How much do you feed? Please list brand and type of food (i.e. Lafeber Avi-Cakes).
- How is water offered?
  
  BowlBottleOther
- What type of water is offered?
  
  Tap WaterBottled WaterOther
- How often is water changed?
  daily, as needed, etc.
- What is used to clean water container?
  water only, dishsoap, vinegar, etc.
- Upload any previous records, if applicable, and include any photos of your pet and their environment that may be helpful. We strongly recommend at least uploading a picture of their enclosure.
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- Upload Photos and Documents
  
  Medical records, photos of pet, etc. We strongly recommend at least uploading a picture of your bird's cage.
  Cancelof
- Should be Empty: