Bird Information Form (chickens/ducks/Turkeys/gamebirds) NameBreed (species) of BirdBirdSex (if known)AgeHow long have you had this bird?Any eggs laid previously? If so how many and when was the most recent egg?Are you or anyone else eating the eggs?Are you planning to eat meat from this bird or other birds in the flock?Band or microchip? Number if knownType of Diet:Seeds (Type, brand)Vegetables (Types & Amount)Fruit (Types & Amount)Supplements or Vitamins (Type)Pellets or crumble (Brand and type -layer/maintenance, etc if known)What type of housing does your bird live in?Does he/she roam free outside of an enclosed pen? (Pasture, Farm, etc?)Any recent change in the appearance of the droppings-please describe?Pertinent Medical History (any past veterinary visits, health concerns):Do you own any other birds? If so, type and age?Have you recently purchased new birds? If so, when, what type of bird and where did they come from?Does this bird have direct contact or live in the same room with these other birds?Purpose of Today's Visit
