[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-307731-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-307731-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","avian-history-form-veterinary-patient-intake-questionnaire","AVIAN HISTORY FORM - Veterinary Patient Intake Questionnaire","","A detailed avian patient history intake form designed for exotic birds to support appropriate veterinary care. It collects comprehensive information including species identification, age, sex, origin, reproductive and molting history, vaccination status, wing trimming, contact with other birds, and relevant recent illnesses. 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Please complete this form as accurately as possible. If there is anything you are unsure about you can discuss it in more depth with the veterinary staff during your appointment.  \nPATIENT BLUE CARD STAMP  \n\n| ANIMAL DETAILS\u003Cbr>Avian name or identification:  . Common or scientific species name:  .\u003Cbr>Date ofbirth:  . Age:  .\u003Cbr>Sex: M 􀀓 F 􀀓 neutered/spayed 􀀓 unknown 􀀓 Determined by: DNA 􀀀 endoscopy 􀀀 visual 􀀀 other: .\u003Cbr>Origin: captive bred 􀀓 wild caught import 􀀓 unknown 􀀓\u003Cbr>How long have you had this bird?  . From where did you obtain this bird?  . Does this bird have a reproductive history? N 􀀀 Y 􀀀; please give details . When did your bird last molt?  . How often has your bird been molting?  . Is your bird vaccinated? N 􀀀 Y 􀀀; please give details:  . Does your bird get wing trimmed? N 􀀀 Y 􀀀; if yes, please give details  . Do you have other birds or pets? N 􀀀 Y 􀀀; please give details: . Have you or your bird had any contact with other birds in the last 30 days? N 􀀀 Y 􀀀; please give details:\u003Cbr>. |  |  |  |\n| --- | --- | --- | --- |\n| When was the last bird added to your collection?  . |  |  |  |\n| REASON FOR PRESENTATION TODAY\u003Cbr>What is the primary complaint or what signs have you noticed? How long have these problems been present?\u003Cbr>. |  |  |  |\n| What health problems has your bird had previously? .\u003Cbr>. |  |  |  |\n| Has your bird received any treatment in the last 30 days? N 􀀓 how often, duration): | Y 􀀓, If yes, please give details (what was used, dosage,\u003Cbr>.\u003Cbr>. |  |  |\n| Have you noticed any change in your bird’s behavior? N 􀀓 Y 􀀓 , please give detail |  | s . |  |\n|  |  | . |  |\n| Have any other animals or persons in the household had any illness in the last 30 da |  | ys? | .\u003Cbr>\u003Cbr>. |\n\nPlease write any other comments or details of relevance on the back of this form  \nUGA Exotic Animal, Wildlife & Zoological Medicine  \n\n| DIET\u003Cbr>How often do you feed your animal? . Indicate which foods are eaten and in what amounts (by number, weight, or approx. volume):\u003Cbr>􀀓 Seed mixtures: Brand? . Amount? .\u003Cbr>􀀓 Pellets: Brand?  . Amount?  .\u003Cbr>􀀓 Fruits and/or vegetables: Type?  Amount?  .\u003Cbr>􀀓 Meat (type and amount);  Freshly killed 􀀓 Frozen/thawed 􀀓 Live prey 􀀓\u003Cbr>􀀓 Treats: Brand?  . Amount?  .\u003Cbr>􀀓 Other:  . Do you use any nutritional supplements? N 􀀓 Y 􀀓, if yes what, how much, and how often; .\u003Cbr>. |\n| --- |\n| What water supply do you provide? tap water 􀀓 bottled water 􀀓 rain/river water 􀀓\u003Cbr>How is water provided? bowl 􀀓 dripper system 􀀓 spray 􀀓 , how often; . How often is the water changed?  . Do you use any water supplements? N 􀀓 Y 􀀓, please give details;  . Have you noticed any changes in feeding or drinking behavior? Please give details; .\u003Cbr>. |\n| Have you noticed any changes in droppings (fecal material, urine and urates)? Please give details; .\u003Cbr>. |\n|  |\n| CAGE ENVIRONMENT\u003Cbr>Where is the cage located? inside 􀀓 outside 􀀓 , please give details; . What is the cage made of?  . Cage size: . What kind of bedding is used?  . What décor and furnishings are present? nest box 􀀀 perches 􀀀 swings 􀀀 toys 􀀀 other:  ; please give details; . Are bathing/spraying facilities provided? N 􀀓 Y 􀀓 , please give details; . How often is the cage cleaned? . What cleaning/disinfectant agents are used?  . What percentage of time does your bird spend inside and outside of its cage? Inside  . Outside . Is the animal supervised when out of the cage? N 􀀓 Y 􀀓 , please give details; . Does your bird have regular exposure to sunlight? N 􀀓 Y 􀀓 Frequency and length of time   Is your bird exposed to full spectrum (UVA and UVB) lighting? N 􀀓 Y 􀀓 Brand?  . What is your bird’s light/dark cycle? . Does anyone in the household smoke? N 􀀓 Y 􀀓 Do you use any aerosolized products? N 􀀓 Y 􀀓\u003Cbr>Have there been changes in the bird’s environment in the last 3 months? N 􀀓 Y 􀀓 , please give deta","cbCaibDKMPVTP6qd","https://ap.wps.com/l/cbCaibDKMPVTP6qd","pdf",96695,"English","# ANIMAL DETAILS\n# REASON FOR PRESENTATION TODAY\n# DIET\n# CAGE ENVIRONMENT","[{\"question\":\"Why is completing the avian history form important for veterinary care?\",\"answer\":\"The form explains that a detailed history is essential to provide the most appropriate veterinary care. It also instructs you to complete it as accurately as possible and discuss uncertainties with veterinary staff during the appointment.\"},{\"question\":\"What information does the form collect about the bird’s background and health history?\",\"answer\":\"It asks for avian name/species, date of birth and age, sex and whether neutered/spayed, origin, time since acquisition, reproductive history, last molt and molt frequency, vaccination, wing trimming, and any contact with other birds in the last 30 days.\"},{\"question\":\"What husbandry and environmental details are requested?\",\"answer\":\"It requests diet components and amounts, water type and delivery method, changes in feeding and droppings, cage location and construction, bedding, furnishings, bathing/spraying, cleaning and disinfectants, supervised cage-out time, sunlight and full-spectrum lighting, light/dark cycle, smoking and aerosol product exposure, and any environment changes in the last 3 months.\"}]","AVIAN HISTORY FORM - Veterinary Patient Intake Questionnaire | PDF",1789853890]