Avian Questionnaire

Owner Information

Name

Phone number

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Email address

Address

Preferred contact method

Radio options for Preferred contact method

Phone Email

Bird Information

Bird's name

Species

Age

Sex

Radio options for Sex

Male Female Unknown

How long have you had your bird?

Where did you acquire your bird?

Radio options for Where did you acquire your bird?

Breeder Pet Store Rescue Other

Diet & Nutrition

What type of food do you feed your bird?

Radio options for What type of food do you feed your bird?

Pellets Seeds Fresh Fruits/Veggies Other

Please list specific brands or types of food

How often do you feed your bird each day?

Do you offer fresh water daily?

Please select… Yes No

Do you provide any supplements?

Radio options for Do you provide any supplements?

Calcium Vitamins Other

Housing & Environment

What type of cage/enclosure does your bird live in?

What are the dimensions of the cage?

What materials are used for perches?

Radio options for What materials are used for perches?

Wood Rope Plastic Natural Branches Other

How often is the cage/water bowl/ food bowl cleaned?

Do you use any bedding or substrate?

Please select… No Yes

If yes, what type?

Where is the cage located in your home?

For example - near a window, in a quiet area, near a kitchen, etc.

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

Are there other pets in the household?

Please select… No Yes

If yes, what kind?

Behaviour & Socialisation

How would you describe your bird’s personality?

Does your bird interact with people regularly?

Please select… No Yes

Does your bird have any known behavioural issues?

For example - feather plucking, screaming, biting, etc.

Health & Medical History

When was your bird’s last veterinary visit?

Has your bird ever been diagnosed with any medical conditions?

Has your bird ever been tested for infectious diseases?

For example - PBFD, Psittacosis, Polyomavirus, etc.

Has your bird ever been on any medications?

Please select… No Yes

If yes, please list them

Does your bird show any of the following symptoms?

Sneezing Discharge from eyes/nose Feather loss or plucking Changes in droppings (color, consistency, frequency) Changes in appetite or water intake Weakness or lethargy Difficulty breathing Fluffed-up appearance Vocalisation changes Lameness or difficulty perching Other (please specify below)

More information

If you have selected "Other" above, please let us have more details

Reproductive History

(for applicable species)

Has your bird ever laid eggs?

Please select… No Yes

If yes, when was the last time?

Does your bird show signs of hormonal behaviour?

Please select… No Yes For example - excessive nesting, aggression, regurgitation, etc.

Additional Information

Any other information

Is there anything else we should know about your bird’s health, behaviour, or environment?

Send