Avian History Form Avian History Form This information will become a permanent part of your bird's medical record. Please take time to complete it as carefully as possible. THANK YOU! Bird's Name:*Owner's Name:*Date Date Format: MM slash DD slash YYYY How long have you had this bird?Where did you acquire it?What do you feed your bird? (Please be specific)Seeds % of dietVegetables % of dietFruit % of dietPellets % of dietWhat time does your bird wake up in the morning?What time does your bird go to bed?Where is the cage located? Kitchen Family Room Bedroom Other What kind of bedding does your pet have? Newspaper Shavings Paper Towels Corncob Pellets Does your bird appear to have any symptoms? Explain:Is your bird... Fluffed Lethargic Not vocalizing Vomiting At the bottom of cage Difficulty breathing When did these symptoms first appear?Has your bird had any previous illnesses? Please specify:Have you noticed any discharge or change in color/consistency of droppings?Has your bird's appetite/behavior changed in any way? Please specify:Does your bird do any plucking or preening in your presence?YesNoWhen did it start?Do you give your bird any supplements?YesNoWhat kind?Has your bird received any medications recently?YesNoIf yes, please list them:Has your bird had any blood, culture, or fecal tests recently?YesNoAny recent changes to your home or your bird's environment? Explain:Has quality time or daily routine with your pet changed recently?YesNoHas your bird traveled anywhere outside the home recently?YesNoDoes your bird have any cage mates?YesNoIf yes, are they showing any signs of illness?YesNoDoes your pet spend any time outside (backyard)?YesNoHas any new birds been added to your aviary or household?YesNoHas your bird boarded/ or been groomed recently?YesNoIf yes, where?Do you have any other questions or concerns?Signature*
