Physical Exam Form

PHYSICAL EXAM FORM

Owner ___________________________________________________Bird’s Name __________________

Type of Bird ____________________________Sex________________Color_______________________

PERTINENT HISTORY:

EXAMINATION:

Head: Eyes____________________________________________________________

Cornea__________________________________________________________

Eyelids__________________________________________________________

Pupillary response_________________________________________________

Cere (color)______________________________________________________

Nares___________________________________________________________

Tongue_________________________________________________________

Mouth__________________________________________________________

Beak____________________________________________________________

Larynx__________________________________________________________

Respiratory sounds_________________________________________________

Ears____________________________________________________________

Neck: Crop____________________________________________________________

Thorax: Sternum__________________________________________________________

Musculature_______________________________________________________

Respiration_________________________Rate____________Depth__________

Auscultation_______________________________________________________

Abdomen: Distance from sternum to pelvis (5 mm is normal in

Parakeet) _________________________________________________________

Palpation__________________________________________________________

Vent_____________________________________________________________

Legs ___________________________________________________________________________

Feet ____________________________________________________________________________

Nails ___________________________________________________________________________

Wings __________________________________________________________________________

Feathers ________________________________________________________________________

Skin ___________________________________________________________________________

EXAMINATION OF THE CAGE

  1. General leve of sanitation?

  1. Husbandry:

Correct cage size? ____ Proper accessories? ____

Is cage safe? ____ Any painted surfaces? ____

Toys safe? ____

3. Perches: Diameter __________

Surface __________

Cleanliness __________

Height in cage __________

4. Droppings: Number_________ Consistency__________

Color___________ Odor __________

5. Diet: What is the bird eating?

Vegetables?____ Greens?____ Fruits?____ Fresh?____ Supplements?____

6. Grit: Size and amount?

7. Cuttlebone: Used?____ Oystershells present?____

  1. Dishes (water, feed, treats):

  2. Are mites present on: Cuttlebone band?____

End of perch? ____

  1. Is cage cover frayed?____

  2. Feathers on floor: Molting?____ Excitement?____

  3. Mirrors: Signs of regurgitation?____

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