| If you need to place your Avian Companion with us, please print out this form and fill it in to the best of your ability. This will help us get to know your bird and help us provide a smooth transition into its new home. |
Parrot Intake Report
Name of Bird :________________________________
Species:______________________________
Band/microchip #:_______________________________ None
Age________________________ Sex M F UNKN DNA Tested Y N Laid Eggs? Y N
Reason for Surrender:
Diet: pellet seed Brand(s):______________________________________________________________________
Favorite foods:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Water: From- Bowl Y N Bottle Y N
Nails trimmed Y N
Wings trimmed Y N If yes, when last done:____________________
Do you have to towel the bird to trim? Y N
Weight. If known:____________________________
Toys:__________________________________________________________________________________________
______________________________________________________________________________________________
Interaction level 1 2 3 4 5 (5 being highest)
Bedtime:
Waking time:
Do you cover the cage at night? Y N
Location of cage in your home: Kitchen Living room Bedroom Other ______________
Heavy traffic Y N
Is there a window? Y N
Is the air Dry Humid Smoky Clear
Behavior-
Vocally interactive: Y N
Favorite
words/noises____________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Screamer Y N
Aggressive Y N
Biter Y N
Plucker Y N
Explain any above:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Socialization:
Social with others Y N with kids Y N Other Birds Y N
Other animals Y N
Health-
Last vet visit _______________ none Last Labwork Done:_____________
Tests Performed:_____________________ vet name________________________ (sign vet release)
Any illness/Injury ? Y N ___________________________________________________________________________
______________________________________________________________________________________________
Any contact with other birds in the past year? Y N If yes, when, where and has the bird been ill since?
______________________________________________________________________________________________
______________________________________________________________________________________________
Does the bird know the step up command? Y N
Does it step up on your Finger Y N Hand Y N Forearm Y N
Shoulder Y N Stick Y N
Does it have a hand preference? R L None circumstance_______________________________________________
_____________________________________________________________________________________________
How do you bathe the
bird?__________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
What other information do you want to share about the bird?
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
________________________________________ _______________
Signature Date
Please Print name_________________________________________________________
Address_________________________________________________________________
Phone: _______________________________
Name of Bird :________________________________
Species:______________________________
Band/microchip #:_______________________________ None
Age________________________ Sex M F UNKN DNA Tested Y N Laid Eggs? Y N
Reason for Surrender:
Diet: pellet seed Brand(s):______________________________________________________________________
Favorite foods:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Water: From- Bowl Y N Bottle Y N
Nails trimmed Y N
Wings trimmed Y N If yes, when last done:____________________
Do you have to towel the bird to trim? Y N
Weight. If known:____________________________
Toys:__________________________________________________________________________________________
______________________________________________________________________________________________
Interaction level 1 2 3 4 5 (5 being highest)
Bedtime:
Waking time:
Do you cover the cage at night? Y N
Location of cage in your home: Kitchen Living room Bedroom Other ______________
Heavy traffic Y N
Is there a window? Y N
Is the air Dry Humid Smoky Clear
Behavior-
Vocally interactive: Y N
Favorite
words/noises____________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Screamer Y N
Aggressive Y N
Biter Y N
Plucker Y N
Explain any above:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Socialization:
Social with others Y N with kids Y N Other Birds Y N
Other animals Y N
Health-
Last vet visit _______________ none Last Labwork Done:_____________
Tests Performed:_____________________ vet name________________________ (sign vet release)
Any illness/Injury ? Y N ___________________________________________________________________________
______________________________________________________________________________________________
Any contact with other birds in the past year? Y N If yes, when, where and has the bird been ill since?
______________________________________________________________________________________________
______________________________________________________________________________________________
Does the bird know the step up command? Y N
Does it step up on your Finger Y N Hand Y N Forearm Y N
Shoulder Y N Stick Y N
Does it have a hand preference? R L None circumstance_______________________________________________
_____________________________________________________________________________________________
How do you bathe the
bird?__________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
What other information do you want to share about the bird?
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
________________________________________ _______________
Signature Date
Please Print name_________________________________________________________
Address_________________________________________________________________
Phone: _______________________________
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