Avian Questionnaire

Patients' Names:

Your Full Name:

Your pet's species*:

Gender of pet (how is this known?):

Length of time owned:

Pre-ownership History:

Has your pet had any disease testing previously and what were the results?:

What is your pets normal feeding regime?:

When did your pet last eat normally?:

When did your pet last eat and what did they eat?:

Any supplements provided to pet (which ones, how often and how provided?):

What type of enclosure is he/she housed in?:

If you would like to upload a photo of the enclosure, please do so:

How often is the enclosure cleaned?:

What is the substrate used?:

Do you have UV provisions?:

Yes
No

If yes, what UV provision do you have and when was bulb last changed?:

Is he/she housed solitary?:

Yes
No

If not solitary, how are the others in the collection?:

If not solitary, does he/she have direct access to any others in collection?:

Does your pet have outside access? :

Yes
No

What is his/her normal activity level?:

What is his/her normal routine?:

How much out of cage time does he/she have and what do they do during this time?:

Is the bird free flighted (inside/outside, supervised/non-supervised?):

What is his/her demeanour and temperament normally?:

Any new birds/animals in collection (when and where acquired from?):

What are you concerned about with your pet today and how long has it been going on?:

Have you given any medications/treatments? :

Security Question: