Pre-visit history Avian

Pet Name *

First

Last

Confirm email address *

Species (ideally scientific name if known) *

Identifiers (microchip or band etc) *

Where did you get your bird? *

How long have you had your bird? *

Gender is... *

If gender is known, how was it determined? *

Acquisition *

Wild caught Captive bred Other/unknown

Does anyone in the household smoke? *

Yes No Unsure

Do you use aerosols in the household? *

Yes No

Last vet visit date and reason. *

Is your bird vaccinated? If yes, when was last one and for what? *

Previous medical concerns (with dates if possible!) *

Has your bird laid eggs in the past? *

Yes No Maybe

Current medications and/or supplements *

Does your bird get wing trims? How often? *

Have you or your bird had any contact with other birds in the last 30 days? Please explain if Yes *

When was the last bird added to your collection? *

When did your bird last go through a molt? *

How often has your bird been molting? *

Please describe the type of enclosure, with dimensions *

Location of enclosure within home *

Other animals in enclosure? *

Enclosure substrate? *

Please list any features (plants, climbing areas, hides etc) *

Any other enrichment? *

Are bathing/spraying facilities provided? If yes, please describe *

What do you use to clean the enclosure? *

What is the water source? *

Does you pet spend time outside the enclosure? If yes, where? *

Is time outside the enclosure supervised? *

Do you use full spectrum UVA/UVB bulb? *

Yes No Maybe

What kind of bulb do you use? *

How long are the lights on/off in Day? *

How long are the light on/off overnight? *

Current main diet (including brand and flavour) *

Where do you feed them? *

Prey items are... *

Live Dead N/a

Are insects gut-loaded? *

Yes No N/a

General behaviour (play, flying, hiding, activities...) *

Known seasonal behaviour changes *

New behaviour changes *

Vomiting *

Yes- Lots Yes- Rarely No

Diarrhea *

Yes- Lots Yes- Rarely No

Coughing or troubles breathing *

Yes- Lots Yes- Rarely No

Lack of defecation *

Yes- Often Yes- Rarely No

Swelling or Discharge from eyes *

Yes No

Wounds *

Yes No

Lump(s) *

Yes- New Yes- Old No

Limping or troubles getting around *

Yes- Lots Yes- Sometimes No

Pain *

Yes No

Parasites *

Yes No

Itching and licking- please score out of 10 (0= no itching, 10= never stops) *

Please elaborate on any identified concerns (eg when it started, frequency of issue, if it is worsening or staying the same etc) *

We would like to keep your pet as calm as possible. What can we do to help make them comfortable? (eg. favourite treats, approaching, tips for handling) *

Pre-visit history form