PET PSITTACINE PHYSICAL EXAMINATION FORM
SECTION I – Please fill out the following section as completely
as possible to better enable us to serve your bird’s health care
needs.
Your name _______________________Today’s Date _________
Your bird’s name________________
Referring Veterinarian if applicable ________________
HISTORY
Species (Common Name)__________________
Scientific name if known____________________
Color(s) _________Age if known_____ Sex: M _ F _ Unknown___
How was sex determined?
Visually (sexual dimorphism)) __ Egg laying__ Endoscopy __ DNA __
Length of time you have owned your bird? ________________
Where was your bird acquired?: Breeder __Pet Store __
Other_____________
Are there other birds in the household and if so, what are their
species?___________________________________________
Are these other birds housed together with this bird? ____________
Are they housed within same room?______________
Are they allowed to socialize out of the cage with each
other?_____________
Does this bird have current or recent exposure to other birds?
(such as pet stores__ boarding__ outdoors with wild bird(s) near
cage__)
If yes to any of the above, please explain and give dates.
______________________________________________.
Other pets?__ Types _______________________________
Interaction between your bird and these pets? ______
If yes, explain ____________________________________
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Patient Medical History
Do we have copies of previous medical records (if
applicable)Y/N
If diagnostics (i.e. blood tests, stool samples, X-rays) have been
performed, are the results of these included in the medical records?
Y/N If not, please list any information that you recall regarding these
results.________________________________________________
Which of the following tests has been performed on your bird?
(Please circle all that apply)
Chlamydophila test Y/N/? Date___ Test type if known __________
Circovirus (Beak and feather disease) Y/N/?
Polyoma virus test Y/N/?
Other (please specify) _______________________
Has your bird had previous treatment for any of the following
conditions? (circle all that apply)
Bacterial infection Y/N
Yeast infection Y/N
Fungal infection Y/N
Chlamydophila Y/N
Toxin exposure Y/N
Parasites Y/N
Respiratory disease Y/N
Intestinal disease/diarrhea Y/N
Heart disease Y/N
Lacerations/skin abrasions Y/N
Fractures Y/N
Malnutrition/Vitamin deficiency Y/N
Gout Y/N
Kidney disease Y/N
Liver disease Y/N
Egg related problems Y/N
Feather disorders Y/N
Eye problems Y/N
Nervous system disease /seizures Y/N
Beak overgrowth Y/N
If yes to any of the above, please give as much detail as possible.
(date of illness, treatment received, and response to treatment)
____________________________________________________
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____________________________________________________
Previous vaccinations given, if known:
Type of vaccine ___________ Date(s) given ___________________
Type of vaccine____________ Date(s) given __________________
HUSBANDRY
Is your bird:
Housed mainly indoors/outdoors (circle one or both as applicable)
Is your bird is taken outside Y/N If yes, when outside is your bird:
In a cage? Y/N
On your shoulder Y/N
Placed in a tree or on a free standing perch? Y/N
Other (please explain)
Do you maintain your bird fully-flighted or are its wings
clipped? ______________
Does your bird shower or bathe? Y/N If so, how often?________
CAGE (please briefly describe the following)
Your bird’s cage location (i.e. kitchen, living room, patio)________
Cage size (length, width, height)______________
Material (i.e. wicker, galvanized metal, painted metal, stainless steel)
_______________________________________________________
Cage substrate (i.e. what is on the floor of the cage)?
____________________________________________________
Can your bird access this material to play with it or ingest it Y/N___
Approximately how many hours of sunlight does your bird get per
week?_______________________________________________
PERCHES
Approximate number of perches on which your bird sits during
the course of a day? __________________
__________
Please check all of the following that apply: Does your bird utilize
perches constructed of or covered by:
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Sandpaper Y/N
Cement Y/N
Wood Y/N If yes, type(s) of wood ____________
Plastic Y/N
Rope Y/N
Other (describe)
Are there toys in your bird’s cage of to which it has access Y/N
If yes, please briefly describe these toys
______________________________________________________
Are any of these toys recent acquisitions Y/N __________
HOUSEHOLD EXPOSURE TO POTENTIAL DANGERS OR TOXINS
Insecticides [ant/flea/roach/mosquito control products] Y/N
Perfumes Y/N
Scented Lotions/Hand Creams Y/N
Fungicides, herbicides Y/N
Disinfectants Y/N
Heavy metals [lead/zinc] Y/N
Stained glass Y/N
Lead solder Y/N
Galvanized wire, screws or metal Y/N
Hair spray Y/N
Solid or plug-in air freshener Y/N
Carpet cleaners Y/N
Mite protector Y/N
Cigarette smoke Y/N
Plastic coated heaters, pans, fabric non-stick cookware Y/N
Mosquitoes Y/N
Peanuts, Brazil nuts, seeds with bugs Y/N
Chocolate Y/N
Avocado or guacamole Y/N
Acetaminophen Y/N
Plants Y/N
Ceiling fans Y/N
DIET
Note: Many disease conditions in pet birds result from nutritional
deficiencies. Despite the statements on seed and pellet products that
these are complete diets, there is no standard to which these foods are
held, and many of them are markedly deficient in various essential
nutrients. The addition of fresh fruits, vegetables and table foods to
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the diet may add positive psychological components and some needed
trace elements, but does not significantly alter the basic deficiencies
seen in most commercial diets. In order to determine to what extent
nutritional deficiencies may be playing a part in your bird’s current or
potential health problems, we must first determine the content of its
diet. Please answer the following questions as accurately as you can.
If needed, we can then assist you in reconstructing your bird’s diet to
improve its health.
What are the main foods offered & consumed daily (i.e. pellets, seeds,
other)___________________________________________________
Brand(s) if known__________________________________________
Other foods offered and consumed on a regular basis (include fruits,
vegetables, snacks, nuts cereals, table foods and any other items
offered and consumed by your bird)
________________________________________________________
________________________________________________________
Supplements provided (vitamins, minerals, cuttlebone, grit etc.)
________________________________________________________
_
Water
Tap Y/N
Filtered Y/N
Bottle/Spring Y/N
Water from outdoor hose Y/N
•
Does your bird dunk its food in the water Y/N
How often is the water usually changed? ________________
Behavioral
If you obtained your bird as a baby or know of its early history,
please answer the following questions:
Was your bird (circle all that apply):
Parent reared Y/N
Hand-reared Y/N
Reared with siblings Y/N
Reared with other young birds Y/N
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Current social and behavioral information:
How often do you handle your bird? (circle one or write in your
answer)
Daily Y/N Occasionally Y/N Never Y/N
If you are having behavioral/socialization problems with your
bird, please circle all of the following that apply:
Screaming excessively or inappropriately Y/N
Refusing to come out of cage Y/N
Refusing to return to the cage Y/N
Biting or attacking people Y/N
Biting or attacking certain individuals Y/N
Falling off perch at night Y/N
Overly reactive/frightened of sudden noises Y/N
Over bonding with certain individuals Y/N
Excessive sexual or masturbatory behavior Y/N
Feather destructive behavior Y/N
Other (please describe)
________________________________________________________
CURRENT PROBLEM (reason your bird is here
today)__________________________________________________
________________________________________________________
_
Has any treatment been given to date for this problem? Y/N
If so, what was this treatment? __________________
____________________________________________
How has your bird responded to this treatment? ________________
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SECTION TWO (Please complete as much of this section as you
are comfortable doing)
Additional questions regarding husbandry, behavior and recent
clinical complaints.
Are fluorescent lights used where bird is kept Y/N
If no outdoor exposure, are any UV lights provided Y/N
If
-
selective aggression is present, does it involve:
One individual Y/N
All individuals except the primary “mate” surrogate Y/N
Cage territoriality/aggression Y/N
Reaction to the presence of other birds, objects, or peopleY/N
A predictable event, or sudden, unexpected aggression Y/N
Anything else about the aggression that we should know?
(explain)______________________________________________
_
If increased/excessive screaming is a problem, does it involve:
A set, predictable time of day Y/N
(explain) _______________________________________
A reaction to their favorite individual leaving the room Y/N
An increase when people are having a conversation Y/N
An increase when someone is talking on the telephone Y/N
A reaction to the presence of other pets Y/N
A reaction to other noises (i.e. vacuum cleaner, dryer,
dishwasher, doorbell) _______________________________
A relationship to where the bird is at the time Y/N (i.e. in its
normal cage, on a T-perch, loose in the house, in a sleep cage?)
_(explain)______________________________________________
If feather destructive behavior is a problem,
What is the duration of the behavior? ___________
Is it progressive, consistent or increasing in severity?______
What parts of the body are affected? (see diagram)
Is there any potential for preening by other birds Y/N
Do you see your bird pick feathers Y/N
Frequency of noticeable molt [times per year.]) _________
Last heavy molt ________/________/_________
Are any products (mite spray, preening aids) applied to skin or
feathers Y/N ________
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Are there feathers on the cage floor when you arrive home Y/N
Are there feathers on the floor of the cage in the morning Y/N
Does your bird vocalize when it picks out a feather Y/N
Can you think of any changes that were made in the environment
around the time that the feather destructive behavior began? Y/N
(If there were changes, please describe)_______________________
Is the food that your bird receives (seed or pellet) of variable colors
Y/N
Are there instructions on the seed or formulated diet to keep it
refrigerated/frozen Y/N
(Note: If the formulated diet or seed contains dyes, and there
are preservatives in the food eliminating the requirement for
refrigeration, this is an appropriate time to initiate a discussion
with the owner on the potential role of dyes and preservatives
in feather destructive and other problematic behaviors).
CURRENT PROBLEM (After reading what the owner has described,
these additional facts may be pertinent)
Is your bird
Talking less Y/N
Playing less Y/N
Sleeping more Y/N
Less mobile in the cage Y/N
Sitting with feathers fluffed for longer periods Y/N
Less interested in its surrounding Y/N
Sitting in the same location for prolonged periods Y/N
Vocalization: Have you noticed:
• voice change Y/N
• loss of voice Y/N
• clicking Y/N
• wheezing Y/N
Have you noticed the following?
Decreased appetite Y/N
More selective appetite Y/N )explain)__________________
Anorexia Y/N
Coprophagia Y/N
Polyphagia Y/N
Polydipsia Y/N
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Polyuria Y/N (assist owner in differentiating from diarrhea)
Drinking less Y/N
Vomiting or regurgitating Y/N
Weakness of grip Y/N
SEXUAL BEHAVIOR:
Female:
Sexual display Y/N To whom or what __________
Nest building activity Y/N
Hiding Y/N
Number of eggs laid _______________________________
Last egg laid [date] _______/______/__________
Small eggs Y/N
Soft shelled eggs Y/N
Abnormal or missing shells Y/N
Previous episodes of dystocia or egg-binding Y/N
Egg bound currently Y/N
History of erratic laying Y/N
Chronic or excessive laying Y/N
Are the eggs left with hen Y/N
History of egg peritonitis Y/N
History of egg peritonitis
Previous history of egg-yolk stroke Y/N
History of cystic ovarian disease Y/N
MALE
Sexual displays Y/N
Increased territoriality Y/N
Masturbation Y/N If yes, quantify and characterize.
Any other differences in behavior you have noticed that we
haven’t covered?
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
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SECTION THREE (To be completed by the technician and doctor,
though reading through this may give you some valuable
information)
PHYSICAL EXAMINATION
MAP OF FINDINGS
[Harcourt Brown]
BODY CONDITION
Body weight____________ g
Hydration Normal _ Dehydration<5% __ <6-10% _ <10%___
Emaciation Y/N
Underweight Y/N (percent or by how any grams? (________)___
Amount of body fat None ___ Trace ___ Light ___ Obese ___
Lipoma(s) Y/N Where located? _(see diagram) ______________
FEATHERS
Clipping of wings:
IS BIRD CURRENTLY FULL-FLIGHTED? Y/N
Owner declines clipping Y/N
Wing clipped: Now Y/N Previously Y/N
Wing clipped: Right Y/N Left Y/N Both Y/N
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Abnormal molt Y/N (describe) ____________
Chronic pin feathers that fail to open Y/N
Is there retained keratin in the feathers of head Y/N Body Y/N
Saw-toothed edges to feathers [failure to zip] Y/N
Broken, malformed or bent feathers Y/N
Lack of powder down when applicable Y/N
Dull appearance to feathers Y/N
Stained or dirty Y/N Generalized or localized ________________
Stress lines/bars Y/N
Flexibility of feather at 180° tip to base: (test of feather integrity)
• Breaks when bent Y/N
• Bends and remains bent Y/N
• Indents when flexed/N
• Straightens back to normal when released Y/N
Are there malcolored feathers [abnormal for species, i.e.. black on
normally green or blue feathers, pink on red feathers ; yellow
coloration to normally blue, green or white feathers; white
discoloration of hyacinth feathers ; red pigment in grey feathers] Y/N
If yes, describe: Color, location, onset:
__________________________________
Over-preening , picking, or other feather destructive behavior Y/N
Feather dystrophy Y/N
Multiple feathers in follicles Y/N
NAILS & BEAK
BEAK
Is beak symmetrical Y/N
If no, describe abnormity (scissors beak, prognathism, beak trauma,
groove in beak from nare (previous rhinitis, other)
________________________________________
Overgrown Y/N
Friable Y/N
Hyperkeratinization Y/N
Small scratch abrasions from concrete perch evident on beak Y/N
NAILS
Missing nails Y/N (list)
Abnormally curled Y/N
Otherwise deformed Y/N If so, describe
_________________________
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SKIN
Flaking Y/N
Pruritic Y/N
Other lesions (erythema, excoriations, scabs, lacerations, necrotic
areas, etc.) List and see diagram ________________________
Cutaneous or subcutaneous masses Y/N describe ___________
Loss of normal grooves –(thin shiny skin) Y/N Where located
_______________________________________________
Pododermatitis Y/N Where located and degree
________________________________________________
Self-cannibalized [mutilation] Y/N Where located _________
Burn Y/N Where located ___________________
Bite wounds Y/N Where located ________________
(Note: with the history of an encounter with a dog or cat, one should
assume that a bite wound has occurred whether or not a wound is
detected)
Cloaca
Vent lips normal Y/N
Diameter of vent and tone normal Y/N
Mucosa of cloaca normal thin, clear tissue Y/N
Irritation, ulceration, cobblestone appearance or papillomas noted Y/N
(If yes, further diagnostics are indicated).
Is a uropygial gland normally present or absent in this species? ____
If present, us the uropygial gland normal in size and symmetry Y/N
Able to express small amount of sebum from papilla Y/N
Epaxial Skeleton
Wings:
Symmetrical at rest (i.e. no wing droop) Y/N
Bilaterally symmetrical on extension Y/N
Symmetrical range of motion Y/N
Pain on palpation, extension or flexion Y/N
Swelling or thickening of any joints Y/N
Skin of patagium healthy and elastic Y/N
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Legs
Tibiotarsal length ___
Chordal length ___
Symmetry of legs when extended Y/N
Range of motion of leg joints – bilaterally symmetrical Y/N
Pain on extension or flexion Y/N
Weakness of grip when perched Y/N
Favoring one leg when perched or ambulating Y/N
Feet abnormally warm Y/N
Posture (erect, drooped, unstable) Y/N
If yes, describe __________________________________
Toes – missing Y/N _____________
Toes deformed/luxated Y/N __________________
Sternum
Carina of keel – smooth, straight Y/N
Breast muscle bilaterally symmetrical Y/N
IF BLEEDING IS OR HAS BEEN PRESENT:
Bleeding/bruising of:
• sternum
• distal wing (note: bleeding from wing tips may be from skin tears,
bruising or damaged blood feathers and these must be differentiated)
• skin Y/N location? ______________
• beak Y/N If yes from beak tip trauma Y/N Bite wound Y/N Skin at
commisure Y/N)
Blood feathers Y/N
Cloacal blood
Frank red blood in feces Y/N
Occult blood in feces Y/N
Black feces Y/N
Frank blood from cloaca independent of droppings Y/N
Hemolyzed blood in urine
Occult blood in urine Y/N
“Chocolate milk” methemaglobin in urine Y/N
ABDOMINAL PALPATION
Normal or increased sterno-pubic distance Y/N
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Palpable fluid in sternopubic area Y/N Severity/extent of fluid? ___
Masses palpable in sternopubic area Y/N
ORAL EXAMINATION
Choana:
Choanal papilla normal Y/N
Papillomas in oral cavity Y/N
Presence of plaques Y/N
Abscesses near glottis at base of tongue Y/N
Infundibular cleft visible Y/N
Infundibular cleft swollen or discharge present Y/N
Submandibular space abscess Y/N Wounds Y/N
RESPIRATORY /CARDIOVASCULAR
Dirty feathers over nares Y/N
Nasal discharge Y/N Character ___
Nares enlarged or distorted Y/N
Dry [lith], hard mass in nares Y/N
Infraorbital sinus swollen Y/N _______________
Excessive sneezing Y/N
Dyspnea Y/N
If yes, characterize the dyspnea.
Is neck extended and does the bird vocalize with inspiratory dyspnea
Y/N
Is there increased abdominal movement Y/N
Open mouth breathing Y/N Tail-bobbing Y/N
Panting with exercise Y/N
Cessation of panting within 2-3 minutes Y/N
AUSCULATATION
Respiratory Rate _____
Heart Rate ________
Cardiac murmur Y/N
Arrhythmia Y/N ________________
Air sacs audible Y/N _____________
Lung sounds audible Y/N ___________
NEUROLOGIC - SENSORY
Ears
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Presence of symmetrical openings Y/N
Discharge or matting of feathers Y/N
Pruitis, excessive scratching at ears Y/N
Fluid or material visible beneath tympanic membrane Y/N
Head tilt Y/N
Eyes
Symmetrical size when viewed head-on Y/N
(If not, R/O glaucoma, exophthalmos, sinusitis, micro ophthalmia,
retrobulbar mass)
Redness or hyperplasia of conjunctiva Y/N
Blepherospasm Y/N
Corneal opacity Y/N
Clarity of lens Y/N
Eye color consistent with age and species Y/N
Pupillary light response Y/N
(Note consensual response is not present in birds, and
voluntary constriction can occur, so interpret carefully)
Eyelid margins normal Y/N
Does the bird appear visual Y/N
REPRODUCTIVE
FEMALE
Abdominal palpation suggestive of egg retention Y/N
Evidence of cystic ovarian disease
Egg-yolk peritonitis Y/N
Egg-yolk stroke Y/N
Hyperostosis on radiographs Y/N
Increased serum calcium Y/N
Male
Is the vent irritated Y/N
Change in cere color (budgerigars) Y/N
DIGESTIVE
Regurgitation
Passive or active regurgitation noted Y/N
Passively regurgitates water when handled Y/N
Delayed crop emptying Y/N
Food retained in crop/crop distention Y/N
Odor to crop contents
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Droppings:
Odor to feces Y/N
Decreased/increased amount Y/N
Yellow or green in urine Y/N
Yellow or green in urates Y/N
Change in feces color Y/N
Increased liquid in urine Y/N
Increased powdered urates Y/N
White, fluffy droppings Y/N
Undigested food in feces Y/N
Dark brown, black tarry or coffee ground feces Y/N
Parasites or eggs in feces Y/N
Bubbly, gaseous droppings Y/N
Scant feces Y/N
Diarrhea Y/N
Pasting of vent Y/N
GRAM’S STAIN OF DROPPINGS
Normal numbers of digestive bacteria [100-150/high power field] Y/N
Decreased number of bacteria Y/N (______/field)
High % gram-positive rods [>90%] Y/N
Low %’s gram-positive cocci [<10%] Y/N
Gram-negative rods Y/N >1% >10% >30% >90%
More than 5-10 yeast per field Y/N
More than 10% budding yeast Y/N
Clostridial sp. present Y/N
Undigested fiber Y/N
RBCs in gram stain Y/N
WBCs in gram stain Y/N
Megabacteria (Macrorhabdosis) in gram stain Y/N
Fungal or yeast hyphae in gram stain Y/N
Contributors:
Teresa L Lightfoot
Greg J. Harrison
Jan Hooimeijer
Nigel Harcourt-Brown
Tom Tully
Bob Doneley
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