Owner First Name *
Owner Surname *
Owner Phone Number *
Bird Name *
Were any new pets introduced to the household recently? If so, were were they acquired from, and when? *
If their diet has changed recently, please describe. List all foods offered, including the amount.
What treats do they receive? Include the amount and frequency of each. *
Is parasite prevention up to date? What was applied/administered, and when? *
Have their housing arrangements changed? Leave blank if not.
How many hours of daylight do they get per day (vs. how many hours they spend covered at night)? *
How much time is spent out of the cage per day? *
Describe the problem, including when it started? *
If you have other birds in the household, are any others affected?
Has there been a recent change in environment? *
Have you noticed any vomiting/regurgitation or diarrhoea? If so, describe the frequency, and when it was first noticed. *
Have you noticed any breathing changes, or a tail bob? *
Have you noticed any coughing or sneezing? If so, describe the frequency, and when it was first noticed. *
Have they been fluffed up, or sleeping more recently? *
Have you noticed a change in their voice? *
Has there been a recent change in behaviour? If so, please describe. *
Has there been a recent change in thirst or appetite? If so, please describe. *
If they have a history of laying eggs, when did they last lay? Have they ever laid soft-shelled eggs?
Please list any known health issues, medical problems, or long-term medications. *
Do you have any questions for the vet which haven't been mentioned in the above history questions?
