Avian Health History Form

AVIAN AUTO HISTORY FORM

  1. What symptoms does your bird show?

  1. When did these symptoms first appear?

  1. How frequently do these symptoms appear?

  1. In your opinion, what is your bird’s chief problem? What caused it?

  1. Is there any previous history of illness?

  1. Are there any recent medications or therapy?

  1. Do cage-mates show any signs?

  1. Any new additions to your aviary or pet bird family? If so, what species? Age? When were they introduced? Where did they come from?

  1. Have there been recent changes in environment?

  1. Activity normal?

Ability to fly normal?

Walking and perching normal?

Listless?

Restless?

Shifting weight from one foot to another?

Any lameness or limping?

Squatting on perch or floor?

Straining as if to defecate?

Wings held away from body/Head drawn back

Into chest?

Sits crouched with feathers ruffled?

Stretching?

Fainting?

Shivering?

Does the tail bob up and down?

Eyes closed or partly closed?

Any enlargements or change of skin or legs?

Any vomiting or re-gurgitation?

If yes, do you see mucous or seed?

11. Appetite (circle): Normal? Abnormal?

If abnormal, is your bird eating More? Less?

12. Describe your bird’s diet:

13. Is there a craving for (circle): Certain food? Grit? Paper? Plant?

14. What supplements are given? Vitamins? Minerals?

15. How much water does your bird drink each day?

16. Droppings (circle): Normal? Abnormal? What consistency:

Firm? Loose? Water?

What color _____________________________________

17. Feathers (circle): Normal? Molting? Scratching? Picking?

  1. What is your bird’s breeding history?

General Condition ____________________________________________________________________

Conformation ______________________________________________________________________

Attitude ___________________________________________________________________________

Weight ____________________________________________________________________________

Posture ____________________________________________________________________________

Droppings __________________________________________________________________________

Color ______________________________________________________________________________

Odor _______________________________________________________________________________

Consistency _________________________________________________________________________

PCV ______________________________________ Plasma Protein ______________________________

PROBABLE DIAGNOSIS:

RX:

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