Avian Medical History

Date

Owner last name:

First NameLast Name

Bird's name:

First NameLast Name

Has your bird been sexed?

Method of sexing:

Does your bird have a microchip?

Describe why you brought your bird to see us today:

Please select any current symptoms:

Has your bird had any precious illnesses or treatments?

Previous Veterinarian:

Have you requested records to be sent to us?

Is your bird vaccinated?

For what diseases?

Where did you obtain this bird?

How long have you owned this bird?

Describe anything you know about your bird's life before living with you:

List any other birds in the house:

How does your bird entertain itself?

Select all that characterize your bird's personality:

Describe the diet that is offered: list brand names, quantities, proportions, and contents. What is eaten? What is found onthe bottom of the cage? Have appetite or dietary preferences changed?

List any supplements provided (e.g. vitamin/mineral powders/liquids, cuttlebone, grit).

Describe caging and perches in terms of sizes, construction materials, and location.

How often do you clean the cage, and cleaning products used

Do you allow this bird to fly?

Describe toys: how many, construction materials, destructibility, and rotation schedule.

List any other items in cages or on/around perches.

Describe bathing routine: how often, what is used, how does the bird respond?

Where does the bird sleep? How many uninterrupted dark/quiet hours per night?

Describe lighting in terms of intensity, source, and hours per day. Is the bird exposed to natural sunlight that has not been filtered through glass or plastic? If so, how often and for how long?

Any possible exposure to hazards including: metals, insecticides, plants, vapors, exhaust fumes, aerosolized particles, contaminants on handler’s skin or clothing (e.g. cigarette smoke residue, perfume, or cosmetics), garden chemicals, cleaners, bathing sprays, cooking vapors, contact irritants, potential allergens?

Bird’s Behavior

Screaming?

Biting?

Is bird kept flighted?

Egg laying/hormonal behaviors/regurgitation?

Bonded to one person?

Does bird forage for food or treats?

Does bird play with toys?

Feather chewing or plucking?

Mutilation of skin/feet?

STATEMENT OF FINANCIAL RESPONSIBILITY

I am aware that I am responsible for all charges related to medical services that my pet receives at Brook-Falls Veterinary Hospital & Exotic Care. I understand that I will be asked to leave a deposit for medical services should my pet require a hospital stay. I understand that I must pay in full at the time medical services are completed. I have been advised that any charges revealed during post care audits will be invoiced in a timely manner and remain my financial responsibility.

Signature

Date

FEATHER PICKING HISTORY

PLEASE COMPLETE THIS SECTION ONLY IF YOU BIRD HAS FEATHER LOSS OR MUTILATION

What date did the feather picking or self-mutilation begin?

Has the bird picked feathers in the past, stopped, and then resumed picking?

Was it seasonal? If so what season?

Did the feathers return? If so did they appear normal?

Was it associated with any other behaviors? i.e. mating or nesting?

Does the bird also groom itself normally? If so, describe grooming in terms of frequency and duration.

Does the bird pick when alone and no human is present?

Does the bird pick when you or others are present?

Is it most commonly associated with a certain person?

Describe bird’s behavior while plucking.

How do you or others respond?

What does the bird do with the feathers?

Does your bird seem itchy?

Does your bird scream or vocalize when picking?

Will your bird interrupt an activity (i.e. eating) to pick?

Does the picking correspond to a certain time of day?

YOUR BIRDS MEDICAL HISTORY