Avian History Form

*Owner's Name



*Pet's Name



Sex (M/F/Unknown)

How was the bird's sex determined? (Surgically/DNA/Other?)

Identification? (Tattoo, Microchip, Band)

Is your bird a pet or breeder? If it has produced young or eggs please describe.

Source of Bird
Where did you get your bird? (Store, Private Party, Breeder, Other)

Date Acquired

Wild Caught or Domestic Bred?

Has the bird been quarantined? If so please describe (Commercial, Private, length of time)

Was the bird isolated prior to introduction to present location? If so, please describe (length of isolation, other birds in isolation area, any bird deaths during isolation period)

Present Environment
Where is the bird kept? (Cage, Aviary, Free in House, wings clipped)

Are there any other birds in the home/aviary?

Are any other birds sick? If so have any died? Please describe

List any toys available to bird

What is used on the bottom of the cage?

List other pets in the home

Please describe the frequency and method of cage cleaning

Please describe the frequency and method of cleaning food/water dishes

How many hours of darkness does the bird have each day?

Describe diet. (Food type; pelleted, seed, table food, combination, brand, ect)

Describe the amount of food offered and eaten each day

How is water offered? (Cup, tube)

Any recently added foods or dietary changes?

Psittacosis (Y/N)

Beak and Feather Disease (Y/N)

Polyomavirus Bornavirus (Y/N)

Fecal (Y/N)

Blood Count (CBC) (Y/N)

Blood Chemistry (Y/N)

X-Rays (Y/N)

Culture (Y/N)


Please describe any vaccines the bird has been given and date given:

Has the brid been seen by another veterinarian? If so please describe when and why

Is the bird currently on or ever been on medication? If so please describe

Additional Comments
Any additional comments