Personal |
*Owner's Name
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*Phone
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*Address
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*Pet's Name
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Species
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Age
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Sex (M/F/Unknown)
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How was the bird's sex determined? (Surgically/DNA/Other?)
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Identification? (Tattoo, Microchip, Band)
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Is your bird a pet or breeder? If it has produced young or eggs please describe.
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Source of Bird |
Where did you get your bird? (Store, Private Party, Breeder, Other)
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Date Acquired
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Wild Caught or Domestic Bred?
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Has the bird been quarantined? If so please describe (Commercial, Private, length of time)
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Was the bird isolated prior to introduction to present location? If so, please describe (length of isolation, other birds in isolation area, any bird deaths during isolation period)
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Present Environment |
Where is the bird kept? (Cage, Aviary, Free in House, wings clipped)
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Are there any other birds in the home/aviary?
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Are any other birds sick? If so have any died? Please describe
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List any toys available to bird
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What is used on the bottom of the cage?
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List other pets in the home
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Please describe the frequency and method of cage cleaning
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Please describe the frequency and method of cleaning food/water dishes
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How many hours of darkness does the bird have each day?
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Diet |
Describe diet. (Food type; pelleted, seed, table food, combination, brand, ect)
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Describe the amount of food offered and eaten each day
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How is water offered? (Cup, tube)
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Any recently added foods or dietary changes?
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Tests |
Psittacosis (Y/N)
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Beak and Feather Disease (Y/N)
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Polyomavirus Bornavirus (Y/N)
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Fecal (Y/N)
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Blood Count (CBC) (Y/N)
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Blood Chemistry (Y/N)
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X-Rays (Y/N)
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Culture (Y/N)
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Other
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Vaccines |
Please describe any vaccines the bird has been given and date given:
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Has the brid been seen by another veterinarian? If so please describe when and why
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Is the bird currently on or ever been on medication? If so please describe
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Additional Comments |
Any additional comments
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