Owner First Name *
Owner Surname *
Owner Phone Number *
Bird Name *
Species *
Age *
Gender * Unknown Male Female
Where were they acquired (breeder, pet shop, rescue organisation etc.) and how long ago? *
Are there any other birds/animals at home? If so, please list. *
Were any new pets introduced to the household recently? If so, were were they acquired from, and when? *
Describe their diet: list all foods offered, including the amount. *
What treats do they receive? Include the amount and frequency of each. *
What parasite prevention is used for internal & external parasites (if any)? How often? When was it last applied? *
Are they housed indoors or outdoors? If both, what percentage of time is spent indoors? *
If they spend any time indoors, where is their cage located in the house? *
For indoor birds, how many hours of daylight do they get per day (vs. how many hours they spend covered at night)? *
For poultry, do they have access to soil? *
Is there any exposure to household toxins? E.g. lead paint, cigarette smoke, incense/oil burners, teflon cooking pans, human medications, insecticide sprays? If so, please list. *
What behavioural enrichment do they receive? E.g. toys, training, puzzles. *
Are they bonded to anyone in the family? If so, who? *
How much time is spent out of the cage per day? *
What is the cage made from, and how big is it? *
Do they have access to metal, including toys? *
What are the perches made of? *
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?
