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What symptoms does your bird show?
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When did these symptoms first appear?
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How frequently do these symptoms appear?
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In your opinion, what is your bird’s chief problem? What caused it?
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Is there any previous history of illness (circle): Yes? No?
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Are there any recent medications or therapy (circle): Yes? No?
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Do cage-mates show any signs (circle): Yes? No?
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Any new additions to your aviary or pet bird family (circle): Yes? No?
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Have there been any recent changes in the environment (circle): Yes? No?
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Activity normal (circle): Yes? No?
Ability to fly normal (circle): Yes? No?
Walking and perching normal (circle): Yes? No?
Listless (circle): Yes? No?
Restless (circle): Yes? No?
Shifting weight from one foot to another (circle): Yes? No?
Any lameness or limping (circle): Yes? No?
Squatting on perch or floor (circle): Yes? No?
Straining as if to defecate (circle): Yes? No?
Wings held away from body/Head drawn back into chest (circle): Yes? No?
Sits crouched with feathers ruffled (circle): Yes? No?
Stretching (circle): Yes? No?
Fainting (circle): Yes? No?
Shivering (circle): Yes? No?
Does the tail bob up and down (circle): Yes? No?
Eyes closed or partly closed (circle): Yes? No?
Any enlargements or change of skin or legs (circle): Yes? No?
Any vomiting or re-gurgitation (circle): Yes? No?
If yes, do you see mucous or seed (circle): Yes? No?
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Appetite (circle): Normal? Abnormal?
If abnormal, is your bird eating (circle): More? Less?
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Describe your bird’s diet:
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Is there a craving for (circle): Certain food? Grit? Paper? Plant?
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What supplements are given (circle): Vitamins? Minerals?
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How much water does your bird drink each day?
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Droppings (circle): Normal? Abnormal?
What consistency (circle): Firm? Loose? Water?
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Feathers (circle): Normal? Molting? Scratching? Picking?
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What is your bird’s breeding history?
