MANOR COURT VETERINARY CENTRE

                          MANOR COURT, TARVIN, CHESTER CH3 8EB

                              PIGEON POST MORTEM REQUEST FORM

 

        

                                                                                REF No. ……...............….

 

Client Name…………………………………………………………………………………..

 

Address………………………………………………………………………………………

 

………………………………………………………………………………………………….

 

e-mail address ………………………………………………………………………………..

 

Contact  Tel No ...............................................................................................

 

Pigeon(s) age …………………………………  Date of death ……………………………

 

Number of Pigeons kept…………………………………………………………………..…

 

Duration of illness*:   less than 2 days  /  2- 7 days / more than 7 days

 

Tick clinical signs that you have seen

 

Abnormal droppings  Yes / No   Description......………………………………………

 

Respiratory signs  Yes / No       Nervous signs   Yes / No  ………………………….  

 

Loss in performance  Yes / No        Loss in weight   Yes / No

 

Other signs ………………………………………………….………………………………….

 

……………………………………………………………………………………………………..

 

Any past history of illness in loft – please describe ……………………………………

 

………………………………………………………………………………………………………

 

Details of any treatment already given and dates

 

…………………………………………………………………………………………………

 

…………………………………………………………………………………………………

 

Signed……………………………………          Date…………………………………….

 

 

Pigeons that have died should not be placed in the freezer prior to submission. They can be put in

the fridge but should be submitted to us ideally within 24 hours of death. Please contact us direct

to inform us of arrival of bird by telephoning  01829-740216

If you have not completed a laboratory request form in the past with details of your loft please send

this form in at the same time.