Avian Pre-Examination

Avian Pre-Examination Form

Species*
Pet's Name*
Where did you acquire your bird?*
How long have you owned your bird?*
What do you feed your bird? (Please list all food items, percentages if multiple food items offered, and what your bird actually eats)*
Do you use a vitamin supplement?*
- Yes
- No
If you use a vitamin supplement, what type do you use?
How often do you feed your bird?*
How often do you clean the food bowl?*
Do you cover your bird at night?*
- Yes
- No
If so, what time do you cover your bird at night?
Does your bird go outside?*
- Yes
- No
Are your bird's wings clipped?*
- Yes
- No
If so, how long ago were they clipped?
What type of enclosure do you have for your bird?*
How big is the enclosure?*
What substrate do you have on the bottom of the cage?
What cage decorations/toys are in the enclosure?
Has your bird been tested for Polyoma?*
- Yes
- No
Please list results.
Has your bird been tested for Beak & Feather disease?*
- Yes
- No
Please list results.
Has your bird been tested for Pachecos (Herpes)?*
- Yes
- No
Please list results.
Has your bird been tested for Psittacosis?*
- Yes
- No
Please list results.
Has your bird been vaccinated for Polyoma?*
- Yes
- No
Has your bird been vaccinated for Pachecos?*
- Yes
- No
Exposure to other birds? Recent handling of other birds?*
- Yes
- No
If yes, please explain.
Are there other pets in the house?*
- Yes
- No
If yes, please list the number and type of pets.
Has your bird had a fecal gram stain performed within the last year?*
- Yes
- No
Has your bird had a blood profile performed within the last year?*
- Yes
- No
Has your bird been DNA sexed?*
- Yes
- No
Has your bird laid eggs?*
- Yes
- No
If so, when was the last time they laid and how many eggs were there?
Please list any previous medical problems or past concerns.*

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