• Avian History Form

  • Patient Information

  • Sex*
  • Sex determined by*
  • Origin*
  • From where did you obtain this animal?*
  • Is your animal vaccinated?*
  • Does this animal have any history of breeding or laying eggs?*
  • Does your bird get their wings trimmed?*
  • Do you have any other pets in the household?*
  • When you acquire a new animal(s), are they quarantined before being introduced to the other animal(s)?*
  • Has your bird had any contact with any other birds outside your household within the past 30 days?*
  • Husbandry Questionnaire

  • Where is the cage/enclosure located?*
  • Is your bird supervised when out of the cage?
  • Do you have a grate separating your bird from dropped food or feces?*
  • What is the cage/enclosure made of?*
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  • How often is the cage/enclosure cleaned?*
  • How often is the cage/enclosure lining or flooring cleaned?*
  • Does your bird have regular exposure to direct sunlight (not through glass or plastic)?*
  • Is your bird exposed to full spectrum (UVA and UVB) lighting?*
  • Do you cover your bird's cage at night?*
  • Does anyone in the house smoke or is the animal around smoke?*
  • Does your bird have a separate sleeping cage/location?*
  • Do you use non-stick cookware?*
  • Do you use an air purifier in the home?*
  • Do you use aerosolized substances/cleaners/air fresheners or any other scented products?*
  • Have there been any changes in the environment in the last 3 months?*
  • Diet/Feeding Regiment

  • Do you provide an additional source of calcium?*
  • How is water offered?*
  • How is type of water is offered?*
  • Have you noticed any changes or have any concerns about your bird's feeding or drinking behavior?*
  • Have you noticed any changes or have any concerns about your bird's droppings?*
  • Appointment Information/Reason

  • Have you noticed any signs, symptoms, or changes in behavior?*
  • Does this animal have any previous medical or health problems?*
  • Have any other animals or persons in the household had any illness within the past 30 days?*
  • Has your bird received any treatments/medications in the last 30 days?*
  • Miscellaneous

  • Should be Empty: