Avian History Form

Owner's Name(Required)








MM slash DD slash YYYY

Please select your birds sex



How was your birds gender determined?




Do you have other pets?(Required)


Have you or your bird had contact with any other pets in the last 30 days?


Does this bird have a reproductive history?


Does your bird get his/her wings trimmed?


Does your bird have any prior health issues?(Required)


Has your bird received any treatment within the last 30 days?(Required)


Have you noticed any changes in your birds behavior? ( Not eating/drinking, lethargic, etc. )(Required)


Please indicate what you feed your bird








What water supply do you provide?(Required)



Have you noticed any changes in your birds droppings (fecal material, urine)?(Required)


Are bathing/spraying facilities provided?(Required)


Is your bird supervised when out of its cage?(Required)


Does anyone in the household smoke?(Required)


Do you use any aerosolized products?(Required)


Have there been any changes in your birds enviroment in the last 3 months?(Required)