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AVES Chicken/Backyard Poultry Husbandry Questionnaire

Many health problems in chickens can arise from inappropriate husbandry. By filling out the information below, to the best of your ability, we can more accurately identify your chicken's health problem/s.

CLIENT DETAILS

First name ^*

Last name ^*

Email ^*

Phone ^*

Address ^*

ANIMAL DETAILS

Animal name ^*

Animal species ^*

Select Dog Cat Bird Guinea Pig Reptile Rabbit Horse Other

Animal breed ^*

Animal color ^*

Animal gender (e.g. male, female, unknown) ^*

Select Female Male

Please note the method that gender was identified, For example DNA, sexing, lays eggs. ^*

Animal DoB or age ^*

Is age accurate or estimate? ^*

How long have you owned your chicken? ^*

Where did you obtain your chicken? ^*

Do you routinely administer any anti-parasite treatments? ^*

Do you own any other chickens/pets? ^*

HOUSING

Coop size and material ^*

Where is the coop located? ^*

Is the coop predator, pest and weather proof? ^*

Number of perches? Perch material? ^*

Furniture (list and describe types and material, nest box and any other furnishings): ^*

What is on the bottom of the coop? ^*

How often is the coop cleaned and with what? ^*

Does your bird free roam in the backyard? If so, how many hours a day?

DIET - Which of the following do you feed your bird:

Please enter the Seed Mix description/brand, amount fed and frequency ^*

Please enter the Pellets description/brand, amount fed and frequency ^*

Please enter the Vegetables/fruit description/brand, amount fed and frequency ^*

Please enter the Grit (shell, egg shells) description/brand, amount fed and frequency ^*

Please enter any Human food/scraps description/brand, amount fed and frequency ^*

Please enter any Supplements description/brand, amount fed and frequency

Please enter any Other description/brand, amount fed and frequency

Type of food dish (number, size, material): ^*

Water dish size, water source and frequency changed: ^*

BEHAVIOUR

Bedtime and waking time:

Does your bird lay eggs? If so, how often and are the eggs normal in appearance?

Do you or your family members consume the eggs?

Does your chicken have any behavioural problems that concern you? ^*

ADDITIONAL INFORMATION

If there are any other important aspects of your chicken's husbandry, please note them here: ^*

What is the primary reason for your chicken's vet visit? ^*

If possible, please bring photos of your chicken's housing. Thank you. We look forward to meeting you soon. AVES

AMENDMENT

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