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Avian Questionnaire
Animal Medical Center of Tyler

Save time at your next appointment! Please complete your required avian questionnaire online from any device at any time before your visit.

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Avian Questionnaire

Please complete this form completely and accurately so that we can get to know you and your pet(s) before your visit. If this is an emergency or your pet requires immediate attention, please call us at (903) 617-6891 for a faster response.

**Please bring a fresh fecal sample to your appointment.**
Pictures of your pet’s enclosure can be sent to amctyler@gmail.com

YesNo
Chlamydophila
Yes
No
Polyomavirus
Yes
No
Psittacine Beak and Feather Disease
Yes
No
Avian Bornavirus
Yes
No

Environment

Diet

YesNo
Cigarettes
Yes
No
E-Cigarettes
Yes
No
Marijuana
Yes
No
Fire
Yes
No
Wood-Burning Fire
Yes
No
Scented Candles
Yes
No
Incense
Yes
No
Aerosols
Yes
No
YesNo
Nasal or ocular discharge?
Yes
No
Coughing or sneezing?
Yes
No
Excessive drinking?
Yes
No
Excessive scratching?
Yes
No
Odd positioning or loss of use in any limb?
Yes
No
Abnormal vocalizations?
Yes
No