Avian Health 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 (circle): Yes? No?

If yes, list the illness:
  1. Are there any recent medications or therapy (circle): Yes? No?

If yes, what medications/therapy:
  1. Do cage-mates show any signs (circle): Yes? No?

  1. Any new additions to your aviary or pet bird family (circle): Yes? No?

If yes, what species?
When were they introduced?
Where did they come from?
  1. Have there been any recent changes in the environment (circle): Yes? No?

If yes, what changes:
  1. 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?

  1. Appetite (circle): Normal? Abnormal?

If abnormal, is your bird eating (circle): More? Less?

  1. Describe your bird’s diet:
  1. Is there a craving for (circle): Certain food? Grit? Paper? Plant?

  1. What supplements are given (circle): Vitamins? Minerals?

  1. How much water does your bird drink each day?
  1. Droppings (circle): Normal? Abnormal?

What consistency (circle): Firm? Loose? Water?

What color:
  1. Feathers (circle): Normal? Molting? Scratching? Picking?

  1. What is your bird’s breeding history?

General Condition
Plasma Protein

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