Avian Patient History Form

Sex *

Does the bird have a reproductive history? *

Is your bird vaccinated? *

Does your bird get wings trimmed? *

Do you have other birds or pets? *

Have you or your bird had any contact with other birds in the past 30 days? *

Has your bird received any treatment in the last 30 days? *

Have you noticed a change in your bird's behavior? *

Have any other animals or persons in the household had any illness in the last 30 days? *

Do you use any nutritional supplements? *

What water supply do you provide? *

Do you use any water supplements? *

Have you noticed any changes in feeding or drinking behavior? *

Have you noticed any changes in droppings (fecal material, urine and urates)? *

Are bathing/spraying facilities provided? *

Does your bird have regular exposure to sunlight? *

Is your bird exposed to full spectrum (UVA and UVB) lighting? *

Does anyone in your household smoke? *

Do you use any aerosolized products? *

Have there been changes in the bird's environment in the last 3 months? *