Phone *
Email *
Avian name of identification *
Common or scientific species name: *
Date of birth *
Age *
Please specify:
How long have you had this bird?
From where did you obtain this bird?
If yes, please give details:
When did your bird last molt? *
How often has your bird been molting?
Please give details:
If yes, please give details:
If yes, please give details:
If yes, please give details:
When was the last bird added to your collection? *
What is the primary complaint or what signs have you noticed? How long have these problems been present?
What health problems has your bird had previously?
If yes, please give details (What was used, dosage, how often, duration):
If yes, please give details:
Have any other animals or persons in the household had any illness in the last 30 days? *
How often do you feed your animal?
Please specify:
Amount
Type/Brand
If yes, what, how much and how often?
How often
How often is the water changed
If yes, please give details:
If yes, please give details:
If yes, please give details:
Please give details:
What is the cage made of? *
Cage size? *
What kind of bedding is used? *
Please give details:
If yes, please provide details:
How often is the cage cleaned? *
What cleaning/disinfectant agents are used? *
What percentage of time does your bird spend inside of its cage? *
What percentage of time does your bird spend outside of its cage? *
Please give details:
Frequency and length of time: *
Brand?
What is your bird's light/dark cycle? *
If yes, please give details:
