Oakland Veterinary Referral Services (OVRS) - Avian Behavior Questionnaire

AVIAN BEHAVIOR CONSULTATION QUESTIONNAIRE

Oakland Veterinary Referral Services

1400 S. Telegraph Rd, Bloomfield Hills, MI 48302

Theresa L. DePorter, DVM, MRCVS, DECAWBM, DACVB
Veterinary Behaviorist

Valerie Tynes, DVM, DECAWBM, DACVB
Veterinary Behaviorist

Resident in Veterinary Behavior Medicine
Adrienne E. Pesavento DVM, Elite FFCP
Arm & Hammer ACVB Resident
General Information
Date and time of consultation (if scheduled):

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDateHourMinutesAM/PM Option
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home phone
Please enter a valid phone number.Format: (000) 000-0000.
Mobile/other phone
Please enter a valid phone number.Format: (000) 000-0000.
What is the best means of contacting you?
Veterinary Clinic
Veterinarian's name
Clinic phone
Please enter a valid phone number.Format: (000) 000-0000.
Who referred you?
This questionnaire is being completed by
Pet Information
Pet's name
Species
Hatch Date
Age
Sex
How determined?

Other
Colors
Weight
Describe your bird’s personality
Your Pet’s Early History
Age obtained
Date obtained
Describe where you obtained your bird and/or their previous type of home/s:(Include the name of breeder/website/advertisement, rescue group/shelter/foster home(s), for how long, with whom, why relinquished and any other details you may think relevant)
If acquired as hand fed baby, describe conditions where hand fed (if known):

Diet and Nutrition
Describe your bird’s meals and feeding routine (including how is the bird fed, list foods offered with % of that diet and list food eaten with % of the diet)
Describe type of treat(s) and when you give them
What is your bird’s absolute favorite treat?
Medical Information
Describe any current, pre-existing or ongoing medical problems

List ALL medication/supplements your pet receives currently or frequently (Behavior and Non-Behavior):

Rows	Medication	Strength	How often given	When started	Purpose
1
2
3
4
5
6
7

Describe laboratory tests (Include blood, urine, x-rays, etc and date performed):
When was the last time your bird was seen by a veterinarian? (provide date and reason)
Activities

Please describe a typical 24-hour day in your bird’s life
Midnight – 4 am
4 am – 8 am
8 am – 12 noon
12 noon – 4 pm
4 pm – 8pm
8 pm – midnight
Is there anything else we should know about your bird’s daily/weekly/monthly routine?
What percentage of time does your bird spend indoors vs outdoors?
Does your bird play with toy(s)?
What are your bird's favorite toys?
How does your bird play with toys?
How often does your bird play with toys?
How often does your bird play with people?

Rows	Name	Occupation	Family relationship	Sex	Age	Describe how they get along with the bird	Present for the consult
SELF
1
2
3
4
5
6
7
8

Rows	Multiple times daily	Once daily	1-6 times per week	1-4 times per month	Less than monthly
Screaming
Other Vocalizations
Lunging/biting owner
Lunging/biting family members
Lunging/biting unfamiliar people
Lunging/biting at cagemate
Lunging/biting other pets
Chronic egg laying
Chewing/biting/tearing skin
Hiding/trembling/ fleeing from people
Hiding/Trembling/ fleeing from animals
Hiding/trembling Fleeing from places
Feather picking

Rows	Enjoys	Accepts willingly	Accepts reluctantly	Resists	Threatens/aggressive	Comments/describe
Nail trimming
Bathing
Petting
Rubbing underwings
Patting head
Hugging / kissing
Stepping up on hand

General Information

Pet Information

Your Pet’s Early History

The Home Environment

Caging

Principle Behavior Concern/s

Diet and Nutrition

Medical Information

Activities

Departure Behavior

Training

Free Flight

Noises

Handling

Your pet's behavior consultation

Deposit for this service is $100.00

General Information

Pet Information

Your Pet’s Early History

The Home Environment

Caging

Principle Behavior Concern/s

Diet and Nutrition

Medical Information

Activities

Departure Behavior

Training

Free Flight

Noises

Handling

Your pet's behavior consultation

Deposit for this service is $100.00*

Deposit for this service is $100.00