Avian Questionnaire At Country Club Animal Clinic

Owner's Name *

Has this bird produced young or eggs? (Please describe)

When did you get your bird? (mm/dd/yyyy)

Are there other birds in the same room? Or somewhere else in the house?

What signs have you noticed regarding this bird, this incident? (Check all that apply)

Has your bird received any treatment for this problem?

Has your bird ever been tested for parrot fever, beak and feather disease, polyomavirus?

What toys are available to your bird?

What do you use on the bottom of your cage?

Do you use sand paper in your cage?

What room of the house is your bird in?

How often do you change out the paper or litter at the bottom of the cage?

How often do you thoroughly clean your bird's cage and what method do yo use to clean it? (Please describe)

How often do you clean your birds dishes and what do you clean them with?

Does your bird eat pellets, seeds, or table foods? (Please describe)

Does you bird eat the following foods often? (Check all that apply)

Vegatables (Check all that apply)

Fruits (Check all that apply)

Do you give any supplements and if so what kind?

How much food does your bird eat a day?

Has your bird had any recent diet changes?

Have there been any recent changes in your bird environment or in your home? (Please describe)

Do you feed high salt foods to your bird?

Do you feed your bird any of the following foods? (Check all that apply)

Does anyone smoke in your house?

Do you use any scent products in your home and if so what kind?