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Avian History

Glenolden Animal Hospital > Online Forms > Avian History

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Form Overview

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Avian History
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Reptile History

Avian History

Owner’s Name

Bird's Name

Date

MM slash DD slash YYYY

Patient Information

Species:

Gender:

Date of birth/hatch:

MM slash DD slash YYYY

Date acquired:

MM slash DD slash YYYY

Method used to determine (e.g. blood test)

Source (pet store, breeder, previous owner):

Number of previous owners (other than breeder, store)

What states and countries has your bird lived in?

Environment

What room(s) is your bird kept in?

Describe the cage- type, size, perches, toys, other furnishings

What is on the bottom of the cage?

Are there are other birds in the house?

Yes

No

If so, what types are they

List any other pets that you have

How much time does your bird spend outside of the cage?

Is your bird supervised when it is out of the cage?

At All Times

Sometimes

No

Do you cover the cage at night or move the bird to a night cage?

List recent changes in the environment, if any:

Exposure History

Has your bird been exposed to birds other than your own?

Yes

No

If yes, which of the following apply?

Boarding

Bird Club/Show

Outdoors

Wild Bird

Friend's Bird, other birds

Other Birds

Toxins

Does anyone in the house smoke?

Yes

No

Is your bird exposed to kitchen vapors?

Yes

No

When was your house/apartment built?

1978 or prior

after 1978

Does your bird chew on painted surfaces (such as walls or windowsills)?

Yes

No

Does your bird chew on houseplants?

Yes

No

Dust

Is there an unusual amount of dust, or any construction near your home?

Yes

No

Do you have air filtration?

Yes

No

Please list any air fresheners, cleaning products, deodorizers, or insecticides that are used in the same room as your bird

Please list other possible toxins or irritants:

Diet

What percent of your bird's diet consists of the following (please describe what the bird actually eats, not what is offered). The total should add to 100%:

Bird Pellets, % amount and brand(s)

Seed mixture , % amount and types/brand(s)

Fruit/vegetables , % amount and types

People food, % amount and types

Other, % amount and types

Treats: types, frequency

Supplements: Multivitamin in ( )water ( )food. Brand, frequency:

Minerals: ( )powder, ( )cuttlebone, ( )block, ( )oyster shell.

Is it eaten?

Yes

No

Is grit offered?

Yes

No

Water source

Please describe any recent additions/changes to your bird’s die

Vaccinations

Please list any vaccine(s) has your bird had and when they were given

Reproductive

Do you plan on breeding this animal?

Yes

No

Possibly

How many clutches of eggs has your bird laid?

or ( )does your bird lay continuously?

When was the most recent egg?

Was the egg ( )normal, ( )thin shelled, ( )misshapen

When was the most recent clutch/litter?

How many eggs/babies were laid?

How many babies have been hatched from this bird?

Does your bird have any behavioral problems?

Behaviors

Feather picking

Screaming

Biting

Aggression

Fear of people

Other

Previous Conditions, Problems, or Surgeries

List with date, if known

Is your bird here for a:

Well-bird check up

Sick bird

If your bird is sick, please describe the signs and how long the bird has been showing these signs:

Is your bird eating normally? (describe)

Have you used any medications from a pet store? (list):

Have you noticed any of the following:

Weight Loss

Weight Gain

Sneezing

Discharge from the eyes or nose

increased breathing rate or effort

decreased ability to fly or exercise

A change in the voice

A change in the droppings

Abnormal feathers

Weakness in the legs or wings

Has your bird been seen by another veterinarian for any of the current problems?

Yes

No

Please list tests performed

Please list medications given

Is there anything else you would like done today?

Additional Services

Nail Trim

Beak Trim

Wing Trim

I have questions about:

Other

If your bird is hospitalized, may we have permission to trim the wings?

Yes

No

This will make medicating your bird less stressful – both in the hospital and at home.

Did you know that avocado ingestion and fumes from Teflon (and other non-stick surfaces) on cookware, self-cleaning ovens, or heaters can be fatally toxic to pet birds? Please ask us if you need help making your home bird-safe

Office Hours

Mon – Fri: 8 AM – 8 PM

Sat: 8 AM – 5 PM

Sun: 10 AM – 2 PM

Office Info

Phone: (610) 237-6120

Address: 405 S MacDade Blvd, Glenolden, PA 19036