Parrot Intake by tQ7Cr31i

VIEWS: 3 PAGES: 3

									                                      Animal Rescue League of Boston
                          PARROT INTAKE PROFILE
                            Please fill this out so we can find the best home for your parrot!


Date: __________
Part 1: Household History
1) Parrot’s name: _______________ Age of parrot? ________ yrs. _________mos.
2) How long have you had your parrot? ______yrs. ______ mos.
3) Why are you giving up this parrot? _______________________________________________________________
4) What would have to happen for you to keep your parrot? _______________________________________________
5) Where did you acquire your parrot?  Animal Rescue League  Other Animal Shelter  Friend/Relative
    Newspaper      Found/Stray  Breeder  Pet Store  Gift  Other_____________________
6) Please describe your household:  Quiet  Active  Noisy
7) Please list the ages of household members your parrot has lived with:
  Men________________________ Women________________________ Children________________________
  Did your parrot have preference over men or women? _____________________
8) Who was the primary caretaker for the parrot? _______________________
9) How did your parrot react when outside of the cage to:
  a. men?      Friendly/Approaches  Playful  Afraid/Runs Away  Bites  No men in household
  b. women?  Friendly/Approaches  Playful  Afraid/Runs Away  Bites  No women in household
  c. children?  Friendly/Approaches  Playful  Afraid/Runs Away  Bites  No children in household
10) How did your parrot react when inside of the cage to:
  a. men?  Friendly/Approaches  Playful  Afraid/Runs Away  Bites  No men in household
  b. women?  Friendly/Approaches  Playful  Afraid/Runs Away  Bites  No women in household
  c. children?  Friendly/Approaches  Playful  Afraid/Runs Away  Bites  No children in household
11) What other animals did your parrot live with?  No other animals in household
   Dogs #____Breed_________________           Cats #___    Other_________________
12) What was the parrot’s reaction to the other animals in your household?
 Ignores  Approaches  Afraid/Runs away/Vocalizes  No contact with other animals in household


Part 2: Parrot’s Cage History
    1) Where is the parrot’s cage located? ___________
    2) What are the dimensions of caging the parrot is housed in? _________________________
    3) Did you cover the cage at night? _____________
    4)   When did you cover the cage at night? _________
    5) How often did you clean your parrot’s cage? ________________________________
    6) Has your parrot ever been housed with another bird?  Never  yes, in household  yes, sharing cage
    7) When alone is your parrot: Free in the house/Confined to a room  In Cage  Television or Radio on



Part 3: Parrot’s Behavior History
1) How much out-of-cage time does your parrot get daily? _________________
2) Does your parrot have a favorite game? ___________________ Know any words?
_______________________________________________________________________
3) How often did you change your parrot’s toys? ______________________
4) Does your parrot like to be petted?    Yes       Tolerates    No, Bites
5) What are your parrot’s favorite types of toys?  Bells  Wood Chews  Plastic  Rawhide  Other
6) How does your parrot respond to visitors?  Friendly  Playful  Afraid/Runs Away  Ignores                  Bites
 Never Sees Visitors
7) Is your parrot frightened of anything?  Thunder  Loud noises  Vacuum  Dogs  Cats
 Men      Women      Children     Strangers      Other: _________________________________________
12) Please tell us about your parrot’s “bad habits”:  Vocal/Screams  Chews on woodwork/Destructive
  Bites without provocation
13) Is your parrot accustomed to:  Bathing        Nail trimming  Medicating


Part 4: Parrot’s Medical History
1) Did your parrot see a veterinarian on a regular basis?     Yes      No
  If yes, what is your vet hospital’s name? _________________________________________________________
2) Does your parrot have any past or present medical conditions?  Yes           No
  If yes, what are they? _________________________________________________________________________
3) Is your parrot currently on any medications or special diets?      _______________________________________
4) What type of food does your parrot eat?     Pellets      Seed  Nuts  Fresh fruits/Veggies  Cooked Fruits/Veggies
 Pasta    Other _____________________
6) Does your parrot get table food?  Yes  No What kinds? _____________________________________________


Part 5: Additional Information
This parrot would do well in a home with the following:
    Kids:  Of any age       Ages 5 and over         Ages 9 and over         Ages 14 and over    No kids at all
    Other Animals:  With Any  Cats only  Dogs only  No dogs  No cats  With None  Other__________
    Visitors:  Many visitors       Few visitors      No visitors
    Someone home:  All day          Most of the day  In the mornings and evenings


Part 6: Please feel free to tell us any additional helpful information
      By signing below, I certify that all information given is accurate and truthful to the best of my
knowledge.


   Signature:        __________________________________________


   Print Name:       ___________________________________________


   Date:              ___________________________________________                                  Revised

                                                                                                    5/7/06

								
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