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 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 diet Vegetables % of diet Fruit % of diet Pellets % of diet What 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 and please text a video or photo to (949)770-9015Is 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? Yes No When did it start? Do you give your bird any supplements? Yes No What kind? Has your bird received any medications recently? Yes No If yes, please list them:Has your bird had any blood, culture, or fecal tests? Yes No Any recent changes to your home or your bird's environment? Explain:Has quality time or daily routine with your pet changed? Yes No Has your bird traveled anywhere outside the home? Yes No Does your bird have any cage mates? Yes No How many cage mates?If yes, are they showing any signs of illness? Yes No Does your pet spend any time outside (backyard)? Yes No How much time outside? Any sun baths? Has any new birds been added to your aviary or household? Yes No Has your bird boarded/ or been groomed? Yes No If yes, where? Do you have any other questions or concerns? Signature*
