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Avian Medical History Checklist

Initial Avian Medical History

Technician_______________________________________________Date______________

Signalment Plus

  • Species __________________________________________________________________________
  • Hatch date/approximate age _______________________________________________________
  • Sex and how it was determined – Female/Male _______________________________________
  • How long have they owned the bird? ________________________________________________
  • Where did they obtain him from? ___________________________________________________
  • Was he quarrantined at time of purchase? – Yes/No
  • Is he hand tamed? – Yes/No
  • Is he fully flighted? – Yes/No
  • Any past medical problems? - Yes/No If yes describe ___________________________________________________________________________________
  • Any other pets at home? - Yes/No If so what are they? _________________________________
  • Have any of your pets died recently? – Yes/No If yes list cause of death and when ____________________________________________________________________________________
  • Are there any cigarette smokers in the home? – Yes/No

Presenting Complaint-Ill Visit

  • What is the bird presenting for today? _______________________________________________
  • How long has it been going on? _____________________________________________________
  • Is the problem progressing, getting better or staying the same?
  • Is he eating/drinking like normal? – Yes/No If not describe _____________________________
  • What is the consistency of the droppings? ____________________________________________
  • Any other pets or people sick at home? – Yes/No If yes who and what illness__________________________________________________________________________________
  • Any change in life style? – Yes/No If yes describe _______________________________________________________________________________________
  • Has there been any weight change? Yes/No Increase/Decrease

Diagnostic History (Have these tests been completed, date and results)

  • Chlamydiosis and Psittacine Beak and Feather Disease test – Yes/No
    Date_____________________Results__________________________________________________
  • Avian Fecal Profile – Yes/No
    Date ____________________ Results _______________________________
  • Culture and Sensitivity cloaca or chloanal slit – Yes/No
    Date ____________________ Results _________________________________________________
  • Chemistry and CBC panel – Yes/No
    Date ____________________ Results __________________________

 

Diet

  • How is his appetite? _______________________________________________________________
  • What brand of food is he eating? ____________________________________________________
  • Pellets/seed? 
    Natural/Organic/Flavored?
  • Type of avian treats _______________________________________________________________
  • How much food is offered daily? ___________________________________________________
  • How much of the food is consumed? ________________________________________________
  • Are any human foods offered? – Yes/ No If so what kind and how much? _________________________________________________________________________________
  • Do they receive any vitamins? – Yes/No
    What kind? __________________________________________________
    How often? ______________________________________________________________________
    Are they given in food/water/by mouth?
  • Describe their water consumption. __________________________________________________
  • How often is the water changed? ___________________________________________________
  • Is the water offered in a bowl or water bottle?
  • What type of water is offered? Tap/bottled/distilled
  • Is he on any supplements? – Yes/No If yes please list name and dose. ____________________
    _________________________________________________________________________________
  • Remember NO caffeine, alcohol, avocado, parsley, or chocolate, these have been known in some cases to be toxic to birds.

Behavior

  • Describe the bird’s personality. _____________________________________________________
    _________________________________________________________________________________
  • Has his attitude changed? – Yes/No If so please describe the change. ____________________
    _________________________________________________________________________________
  • Has his voice changed? – Yes/No If so please describe the change. _______________________
    _________________________________________________________________________________
  • Describe the bird’s molting habit. ____________________________________________________
    _________________________________________________________________________________
  • Describe the bird’s sleeping patterns? ________________________________________________
    _________________________________________________________________________________
  • Does he forage? Yes/No

Grooming (Is he in the need of)

  • Nail trim – Yes/No
  • Beak trim – Yes/No
  • Wing clip – Yes/No
  • Does he bathe? – Yes/No If so how often? ____________________________________________

Cage

  • Describe the cage in detail

Size _____________________________________________________________________________
Brand or material cage is made of ___________________________________________________
Location _________________________________________________________________________

  • Perch material - Manzanita/ribbon wood/wooden dowel/ceramic/nylon/other ____________
    Quantity _________________________________________________________________________
    Location _________________________________________________________________________
  • Bowl material – Ceramic/metal/plastic/glass/other ____________________________________
    Quantity _________________________________________________________________________
    Location _________________________________________________________________________
  • Toy material – Hardwood/softwood/plastic/rubber/chains/cardboard/rope/other __________
    Quantity _________________________________________________________________________
    Location ________________________________________________________________________
    Does he play with toys? – Yes/No
  • What type of substrate is used for cage lining? Newspaper/corncob/sand/gravel/cedar/other _________________________________________________________________________________
  • How often is the cage cleaned? _____________________________________________________
    Water bowl cleaned? ______________________________________________________________
    Food bowl cleaned? _______________________________________________________________
    Perches cleaned? _________________________________________________________________
  • Describe the color and consistency of the droppings. __________________________________
  • Are there any cage mates? - Yes/No If yes, how many and species? ______________________
  • Is the cage covered in the evening? – Yes/No
  • What is the light cycle, does he get 12-14 hours of darkness? - Yes/No
  • Do they spend any time out of their cage? – Yes/No
    If so where are they when out of their cage? __________________________________________
    Are they unattended when out of their cage? – Yes/No
  • Do you take him outside? - Yes/No
    If so, is he caged? - Yes/No 
    Is he protected from the environment? - Yes/No

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