Avian Questionnaire
All fields marked with * are required and must be filled.
Please complete the following questionnaire to help us better understand your bird’s health, environment, diet, and behavior.
Name
*
First Name
Last Name
Bird's Name
Species
Date of Birth (If known)
Sex
Male
Female
Unknown
Other
How was your bird’s sex determined?
Egg laying
DNA sexing
Surgical sexing
Previous veterinary records
Unknown
Other
When did you acquire your bird? Where did you obtain your bird?
Breeder
Pet store
Rescue/shelter
Private individual
Other
Housing & Environment
If you would like, please send us a picture of your housing setup along with the patient’s first and last name to redwoodvet@yahoo.com.
What type of housing does your bird primarily use?
Cage
Aviary
Combination of cage and free-roaming
Primarily free-roaming
Other
Approximate Cage dimensions
Where is the cage located in your home?
Approximately how many hours per day does your bird spend outside the cage?
What types of toys/enrichment are provided?
Are there other animals in the home?
Yes
No
If yes, please list species and number:
Lighting & Outdoor Access
Approximately how many hours of light does your bird receive each day?
Approximately how many hours of uninterrupted darkness/sleep does your bird receive each night?
Does your bird receive UV/UVB lighting?
Yes
No
Does your bird have outdoor access?
Yes
No
Diet
What type of diet does your bird receive?
Does your bird eat pellets?
Yes
No
Brand/type?
Approximate amount offered per day:
Does your bird eat seeds or a seed mix?
Yes
No
Brand/type?
Approximate amount offered per day:
Does your bird receive fresh fruits and/or vegetables?
Yes
No
What fruits/vegetables are regularly offered?
How often are fresh foods offered?
Other Foods & Treats
What other foods or treats does your bird receive?
How often are treats given?
Medications & Supplements
Is your bird currently receiving any medications?
Yes
No
If yes, please list the medication(s), dose, and frequency:
Is your bird currently receiving any vitamins, minerals, or other supplements?
Yes
No
If yes, please list:
Medical History
Has your bird had any significant previous medical conditions or illnesses?
Yes
No
Unknown
If yes, please describe:
Behavior
Are there any behavioral concerns you would like to discuss with your veterinarian?
Yes
No
If yes, please describe:
Pet Owner Signature
*
Today's Date
*
Submit
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