Name *

Email *

Please describe the main reason for bringing your pet in for an exam. Include any observed symptoms or changes in behavior that you’ve noticed. *

Have you attempted any treatments or interventions for your pet’s condition? *

Yes
No

Please provide details about the treatments, their duration, and their impact on your pet’s condition. *

Are there any past health concerns or diagnoses that your pet has experienced? This could include any chronic conditions, surgeries, or ongoing medications your pet has received. Please provide as much information as possible. *

Pet Information

Sex *

How sex was determined *

History

Where did you get your pet?

How long have you had them? *

Have you ever had your bird sexed? *

Molting

When was their last molt? *

How often do they molt? *

Other Pets and Contact

Do you have any other pets *

Has there been any recent contact with any other birds? *

Has any pet or person in the household had any illness in the last 30 days? *

Yes
No

Feeding/Water

Feeding frequency *

Food types and amounts *

How does your pet receive water? *

Bowl
Dripper System
Spray

Behavior and Health

Any changes in behavior *

Yes
No

Details if applicable

Changes in droppings *

Yes
No

Use of nutritional supplements: *

Yes
No

Details if applicable

Housing and environment

What size of cage does your bird live in and water materials are used in it? *

Cage location *

Indoors
Outdoors

Details if applicable

What furnishings and decor is in their environment? *

Bathing facilities *

Yes
No

Sunlight and Routine

How much sunlight exposure do they receive? *

Light/dark cycle *

Out-of-cage supervision *

Yes
No

Environmental Changes

Has there been any recent environment changes *

Yes
No

Details if applicable

Household Factors

Smoking in household *

Yes
No

Aerosolized products *

Yes
No

Use of Teflon pans *

Yes
No

You are welcome to take photos of your pet’s cage setup, foods, medications and supplements. You can then choose from the following options:

1. Bring the questionnaire and photos to the appointment: you can bring the completed questionnaire and the photos with you to the appointment. Our veterinary team will review them during the examination.

2. Email the questionnaire and photos: If you prefer, you can email the completed questionnaire and the photos to us at frontdeskhpmc@gmail.com. Please send the email at your soonest convenience, preferably before the appointment. Our team will review the information to ensure we have a comprehensive understanding of your pet’s care before the visit.

Thank you!

We appreciate your cooperation in providing us with this valuable information, as it will assist us in delivering the best possible care to your beloved pet. If you have any questions or need further assistance, feel free to contact us at
205-772-3288.

Avian Exotic Questionnaire