Report a Possible Case

Please provide as much detail as you can. Reporter information is private and visible only to authorized reviewers.

This report is for review and pattern tracking. It is not a public accusation and does not by itself confirm responsibility for disease transmission.

Reporter Information

Private — visible only to admins.

Reporter name

Email address *

Phone number

City

State

Preferred contact method

May we contact you for follow-up?

Yes No

May this report and supporting documentation be shared privately with appropriate animal health officials if needed?

Yes No

Bird Information

Bird name (optional)

Species

Approximate age

Sex (if known)

Was this bird newly acquired?

Yes No

Date acquired

Date symptoms first noticed

Is the bird still alive?

Yes No

Was a necropsy performed?

Disease Information

Source / Acquisition Information

Use non-accusatory wording. Reported source information is for review only.

Where did the bird come from?

Name of reported source

Source address (if known)

Source city

Source state

Source website or social media link

Was the bird shipped?

Were other birds present at the source?

Did the source provide health records?

Did the source provide disease testing records?

Have you contacted the source?

Yes No

What was their response?

Exposure Information

Has this bird been around other birds since acquisition?

Approximate number of birds potentially exposed

Names/locations of possible exposure sites (rescue, store, vet office, boarding, grooming, club, fair, event)

Are any other birds showing symptoms?

Have exposed birds been tested?

Exposure notes

Veterinary / Authority Contact

Has an avian veterinarian been contacted?

Yes No

Vet clinic name

Has the Department of Agriculture been contacted?

Has animal control been contacted?

Has the source been notified?

Is there an active investigation that you know of?

Notes

Supporting Uploads

Lab results, vet records, receipts, photos, screenshots, necropsy reports, or other documentation. PDF, JPG, PNG, DOCX up to 10MB each, max 10 files.

Required Consent

I understand this report is for review and tracking purposes and does not by itself prove the source of infection.I certify that the information I am submitting is accurate to the best of my knowledge.I understand that administrators may contact me for follow-up.I understand that personally identifying information will not be published publicly without my permission.