Name
Animal Details
Sex
Determined by
Origin
Does this bird have a reproductive history?
Is your bird vaccinated?
Does your bird get wing trimmed?
Do you have other birds or pets?
Have you or your bird had any contact with other birds in the last 30 days?
Reason For Presentation Today
Has your bird received any treatment in the last 30 days?
Have you noticed any change in your bird’s behavior?
Diet

Indicate which foods are eaten and in what amounts (by number, weight, or approx. volume)

Do you use any nutritional supplements?
Cage Enviroment
What décor and furnishings are present?
Are bathing/spraying facilities provided?
What percentage of time does your bird spend inside and outside of its cage?
Is the animal supervised when out of the cage?
Does your bird have regular exposure to sunlight?
Is your bird exposed to full spectrum (UVA and UVB) lighting?
Does anyone in the household smoke?
Do you use any aerosolized products?
Do you have non-stick cookware?
Is your bird exposed to kitchen fumes?
Have there been changes in the bird’s environment in the last 3 months?
Is there anything else you would like done today?
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