Marlborough Bird & Animal Hospital
21 South Main Street Marlborough, CT 06447
Phone (860) 295-1595
www.marlboroughvet.com
Avian Questionnaire
Name of pet: ______Breed: ______Age: ______
Age obtained: ______Where obtained (pet store, breeder): ______
List other pets in the household: ______
______
Any other birds in the cage: Y or N How many? ______
What is the size of the bird cage: ______On a stand?: Y or N
What material is the cage made of? (steel, powder-coated, etc): ______
Do you provide a hiding place for your bird? Y or N
What toys do you provide your bird in the cage? ______
______
What types of perches does your bird have? ______
How many perches? ______
What do you feed your bird? ______
How much and how often? ______
Do you bathe your bird? ______
What do you use to line the bottom of the cage? ______
Where is the birdcage located in the home? ______
How much time does the bird get outside of its cage? ______
Do you take your bird outside? Y or N Do you travel with your bird? Y or N
How much sleep does your bird get? ______
Do you have non-stick cookware in your house? Y or N
Do you use scented candles or burn incense in the home? Y or N
Does anyone smoke in the home? Y or N
Do you have ceiling fans in your home? Y or N
What is the age of your home? ______
Do you know about the disease Psittacosis (Chlamydiosis, Parrot Fever)? Y or N
Has your bird been to a veterinarian before? Y or N
Has your bird ever been tested for any diseases? Y or N Which diseases?
______
Does your bird vocalize excessively? And if so what are the cirumastances and when? ______
Do you or anyone else handle your bird?______
Does your bird bite? Y or N And if so who and what are the circumstances?
______