INTAKE INFORMATION FORM

Please print this form and bring it with you filled in when you bring a bird to us. It will help make the new home much more comfortable.

IOWA PARROT RESCUE

2479 Golden Ave

Letts, IA 52754

Intake Interview                                                       date

1. Bird's Name

2 Species

3. Age

4. sex

5. weight on intake

4. previous medical issues if any

5. Current medical issues if any

6. vet

7. food habits/preferences

8. bathing habits (spray? bathe itself? frequency?)

9. history with other birds

10. sleeping habits (bedtime? covered? night frights?)

11. likes and dislikes (gender preference in people)

12  flighted? Has ever flown?

Owner information:

Name:

Address:

Email:

Where bird was purchased or adopted

How long has bird lived with you

Number of previous owners, if known

Reason for surrendering bird