Avian Husbandry & History Form

To help us prepare for your pet’s appointment, please answer the following questions to the best of your ability and email this form back to us at info@mysouthwestvet.com. Photos of the patient, tank, equipment, etc can also be emailed. Thank you!

Owner Information

Name

First Last

Pet Information

Pet's Name

Species

Approximate Age

Sex

Past medical problems:

Current problem(s), how long has it been going on?:

Pet Background Information

How long have you owned the bird?

here did you get the bird?

When was the most recent molt?

Any problems with molting? Stool quality?

Is your bird tame or frequently handled?

Is your bird flighted?

Any other pets? If yes, what kind(s)?

Interaction with other pet(s)?

Any new birds, even if no direct contact?

Housing

Is the bird housed alone, or with other birds?

Approximately how many hours per day does the bird spend outside the cage?

Cage size?

Cage location?

Perch types used (dowels, natural wood, rope, pumice/stone, etc)?

Other cage furniture/toys?

Are you using any artificial/UV lighting?

Cage lining material?

Frequency of cleaning/products used?

Anything else we should know about your bird?

Nutrition

Approximately what percentage of each of the following makes up your bird's diet, and what type is it (brand or major ingredients)?

Seed mix