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Avian History Form

Instructions: An accurate history of your pet is extremely important. We would appreciate your cooperation in providing us with the following information. Please check the appropriate boxes or use the spaces provided. Thank you.

Are there are other birds in the house?
Is your bird supervised when it is out of the cage?
Has your bird been exposed to any birds other than your own?
Does anyone in the house smoke?
Is your bird exposed to kitchen fumes?
Do you have non-stick cookware?
Does your bird chew on houseplants?
Does your bird chew on painted surfaces (such as walls or windowsills)?
Is there an unusual amount of dust, or any construction near your home?
Do you have air filtration?

What percent of your bird's diet consists of the following (please describe what the bird actually eats, not what is offered): % and brand/types

% and brand(s)
% and types/brand(s)
% and types
% and types
Multivitamin in
Is it eaten?
Is grit offered?
Do you plan on breeding this bird?
Was the egg
Were they healthy?
Does your bird have any behavioral problems?
Is your bird here for a
Is your bird eating normally?
Has your bird been seen by another veterinarian for any of the current problems?
If your bird is hospitalized, may we have permission to trim the wings? This will make medicating your bird less stressful – both in the hospital and at home.

Did you know that avocado ingestion and fumes from Teflon (and other non-stick surfaces) on cookware, self- cleaning ovens, or heaters can be fatally toxic to pet birds? Please ask us if you need help making your home bird-safe.

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