Initial Avian Medical History
Technician_______________________________________________Date______________
Signalment Plus
- Species __________________________________________________________________________
- Hatch date/approximate age _______________________________________________________
- Sex and how it was determined – Female/Male _______________________________________
- How long have they owned the bird? ________________________________________________
- Where did they obtain him from? ___________________________________________________
- Was he quarrantined at time of purchase? – Yes/No
- Is he hand tamed? – Yes/No
- Is he fully flighted? – Yes/No
- Any past medical problems? - Yes/No If yes describe ___________________________________________________________________________________
- Any other pets at home? - Yes/No If so what are they? _________________________________
- Have any of your pets died recently? – Yes/No If yes list cause of death and when ____________________________________________________________________________________
- Are there any cigarette smokers in the home? – Yes/No
Presenting Complaint-Ill Visit
- What is the bird presenting for today? _______________________________________________
- How long has it been going on? _____________________________________________________
- Is the problem progressing, getting better or staying the same?
- Is he eating/drinking like normal? – Yes/No If not describe _____________________________
- What is the consistency of the droppings? ____________________________________________
- Any other pets or people sick at home? – Yes/No If yes who and what illness__________________________________________________________________________________
- Any change in life style? – Yes/No If yes describe _______________________________________________________________________________________
- Has there been any weight change? Yes/No Increase/Decrease
Diagnostic History (Have these tests been completed, date and results)
- Chlamydiosis and Psittacine Beak and Feather Disease test – Yes/No
Date_____________________Results__________________________________________________
- Avian Fecal Profile – Yes/No
Date ____________________ Results _______________________________
- Culture and Sensitivity cloaca or chloanal slit – Yes/No
Date ____________________ Results _________________________________________________
- Chemistry and CBC panel – Yes/No
Date ____________________ Results __________________________
Diet
- How is his appetite? _______________________________________________________________
- What brand of food is he eating? ____________________________________________________
- Pellets/seed?
Natural/Organic/Flavored?
- Type of avian treats _______________________________________________________________
- How much food is offered daily? ___________________________________________________
- How much of the food is consumed? ________________________________________________
- Are any human foods offered? – Yes/ No If so what kind and how much? _________________________________________________________________________________
- Do they receive any vitamins? – Yes/No
What kind? __________________________________________________
How often? ______________________________________________________________________
Are they given in food/water/by mouth?
- Describe their water consumption. __________________________________________________
- How often is the water changed? ___________________________________________________
- Is the water offered in a bowl or water bottle?
- What type of water is offered? Tap/bottled/distilled
- Is he on any supplements? – Yes/No If yes please list name and dose. ____________________
_________________________________________________________________________________
- Remember NO caffeine, alcohol, avocado, parsley, or chocolate, these have been known in some cases to be toxic to birds.
Behavior
- Describe the bird’s personality. _____________________________________________________
_________________________________________________________________________________
- Has his attitude changed? – Yes/No If so please describe the change. ____________________
_________________________________________________________________________________
- Has his voice changed? – Yes/No If so please describe the change. _______________________
_________________________________________________________________________________
- Describe the bird’s molting habit. ____________________________________________________
_________________________________________________________________________________
- Describe the bird’s sleeping patterns? ________________________________________________
_________________________________________________________________________________
- Does he forage? Yes/No
Grooming (Is he in the need of)
- Nail trim – Yes/No
- Beak trim – Yes/No
- Wing clip – Yes/No
- Does he bathe? – Yes/No If so how often? ____________________________________________
Cage
- Describe the cage in detail
Size _____________________________________________________________________________
Brand or material cage is made of ___________________________________________________
Location _________________________________________________________________________
- Perch material - Manzanita/ribbon wood/wooden dowel/ceramic/nylon/other ____________
Quantity _________________________________________________________________________
Location _________________________________________________________________________
- Bowl material – Ceramic/metal/plastic/glass/other ____________________________________
Quantity _________________________________________________________________________
Location _________________________________________________________________________
- Toy material – Hardwood/softwood/plastic/rubber/chains/cardboard/rope/other __________
Quantity _________________________________________________________________________
Location ________________________________________________________________________
Does he play with toys? – Yes/No
- What type of substrate is used for cage lining? Newspaper/corncob/sand/gravel/cedar/other _________________________________________________________________________________
- How often is the cage cleaned? _____________________________________________________
Water bowl cleaned? ______________________________________________________________
Food bowl cleaned? _______________________________________________________________
Perches cleaned? _________________________________________________________________
- Describe the color and consistency of the droppings. __________________________________
- Are there any cage mates? - Yes/No If yes, how many and species? ______________________
- Is the cage covered in the evening? – Yes/No
- What is the light cycle, does he get 12-14 hours of darkness? - Yes/No
- Do they spend any time out of their cage? – Yes/No
If so where are they when out of their cage? __________________________________________
Are they unattended when out of their cage? – Yes/No
- Do you take him outside? - Yes/No
If so, is he caged? - Yes/No
Is he protected from the environment? - Yes/No
Options: Download this file in Word Format | Download this file in PDF format
