AVIAN HISTORY FORM

PLEASE CALL OUR CLINIC AT 403-240-3577 TO SCHEDULE AN APPOINTMENT FOR YOUR PET BEFORE FILLING OUT THIS FORM. THANK YOU!

Full name of Owner/Caregiver (must be over 18 years old):

Phone

Name of pet

Species

Age

Sex

Male Female

Length of time owned

Place of Purchase/Adoption

Was DNA sexing done on your bird?

Yes No

Background Information

If there are other pets at home (other birds, dogs, cats, etc.), please list species, date acquired, and place of purchase/adoption.

Describe breeding history (i.e., eggs laid, etc.).

Please describe your bird’s personality, including if they are bonded to anyone at home.

Husbandry

Please describe your bird’s cage/enclosure including the size of the cage, the material it is made of, location in the home, types of perches and toys present, if it shares the cage with another bird, and what is used to line the bottom of the cage.

Please describe how often the bottom of the cage is cleaned, how often the entire cage is cleaned, and what cleaning products are used.

Please describe your bird’s sleeping routine including hours of sleep, type of cover used on the cage, location of sleeping cage, and if a nightlight is present.

Please describe your bird’s time outside of the cage including how often and for how long it comes out of the cage, whether or not they are supervised, and where the bird spends its time when out of the cage. Please include whether or not they go outside.

Please describe exposure aerosols such as cigarette smoke, fumes from Teflon pans, self-cleaning ovens, scented candles, air fresheners, hair sparys, etc.

Please describe your bird’s bathing/showering routine.

Please describe any recent changes in the home (i.e., new enclosure, different diet, home renovations, new schedules, new pet or new people in the house, moved bird to a new location in the house, etc.).

Nutrition

Please provide details on your bird’s diet (i.e., seeds/nuts, pellets, vegetables, fruit, treats). Include brand names, amounts, and how often you feed your bird.

Please provide details on any supplements you give your birds (i.e., vitamins, grit, cuttlebone, mineral block, etc.)

Please provide details on the water offered (i.e., tap, filtered, bottled), how often the water is changed, and how often the bowl is cleaned.

Medical History

Please describe your pet’s previous medical history/problems.

If your bird is currently ill, please describe the medical concern in detail including the duration of the problem and if the clinical signs are getting worse, better, or not changing.

If your bird is currently on medications, please give the name of the medication, the reason it has been prescribed medication, and the bird’s response to the medication (i.e., is there improvement?)