Skip to content
Toggle Navigation
Home
About Us
Adoptable Birds
Boarding
Forms
Foster Home Application Form
Parrot Guardian Application Form
Parrot Bio Relinquishment Form
SCBR Volunteer Application Form
SCBR Questionnaire
Sponsor A Bird
Avian Vet
Get Involved
News
Contact
916-956-2153
bordend@sbcglobal.net
19084 Dayton Rd
Bend, OR 97703
Donate
SCBR Questionnaire
admin
2023-12-05T17:29:38+00:00
Bird Rescue Questionnaire
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Date / Time
*
Date
Time
Are you the owner of this parrot?
*
Yes
No
Custodian
Other
Other:
Are you the custodian of this parrot?
*
Yes
No
Deceased Family Member
Deceased Spouse
Spouse
Other
Other:
Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Are you using well water at this location?
*
Yes
No
Bottled
Other
Other:
Home Phone
*
Cell Phone
Work Phone
Fax
Email
*
Parrots name
*
Type of parrot
*
Sex of parrot
*
Male
Female
Unknown
Sex of parrot determined by:
*
Surgical
DNA
Unknown
Other
Other:
Does this parrot prefer men, women, or children?
*
Men
Woman
Likes boys
Likes girls
Dislikes children
Unknown
Please provide a brief description of the primary handler(s) of this bird (age, hair color, etc.,)
*
How long have you had your parrot?
*
How old was your parrot when you took him or her in?
*
Age of parrot now?
*
Is the parrot hand tame?
*
Yes
No
Unknown
Other
Other:
Does the parrot prefer right hand or left hand for stepping up?
*
Right hand
Left hand
Both hands
With a towel or other object
Steps up onto a stick
Not tame at all
Unknown
Other
Other:
Does this parrot prefer to step forward or step backward?
*
Forward step
Backward step
Both
Unknown
Other
Other:
Does your parrot have a microchip?
*
Yes
No
Unknown
Other
Other:
Does your parrot have a leg band number?
*
Yes
No
Unknown
Other
Other:
What is the ID number?
Was your parrot used for breeding?
*
Yes
No
Unknown
Other
Other:
Does your parrot become nippy?
*
Yes
No
Only when provoked
When scared
Never bites
Unknown
Other
Other:
If yes, who or what provokes them to bite or nip? (Details are important)
How often do you take your parrot to the vet?
*
Annual checkup
When needed
For grooming
Unknown
Never been to a veterinarian
Other
Other:
When was your parrots last vet visit?
What was the reason for the visit?
What is your Avian Vet's name?
*
Clinic name?
Clinic Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Clinic Phone
Clinic Email
Describe your parrots overall current condition:
*
Has your parrot ever sustained any injuries?
*
Yes
No
Unknown
Other
Other:
Please describe any injuries:
Has your bird ever been treated for any illness or diseases?
*
Yes
No
Unknown
Other
Other:
Please explain the illness or disease and how it was treated:
*
Has your bird ever been given any medications?
*
Yes
No
Unknown
Other
Other:
Please list any medications and reasons for medications:
Has your bird ever been on herbal or other alternative therapies?
*
Yes
No
Unknown
Other
Please describe:
Does your bird have any medical/physical conditions that require reoccurring treatment and/or a specialized perch, cage, or play area?
*
Yes
No
Unknown
Please describe:
Has your parrot had any behavioral issues currently or in the past?
*
Biting
Nipping
Crying out
Screaming
Grinding on hand or toy
None
Other
Other:
What time of day does this parrot cry out or scream, and do you know what provokes him or her?
How do you discipline your parrot?
*
Spray bottle
Put in a second room
Put in a dark room
Cover cage
Yell at them
Unknown
Other
Other:
Does the parrot have any special, obvious identifying marks?
Yes
No
Unknown
Other
Please list identifying marks:
Does the bird's beak require regular trimming?
Yes
No
Unknown
Other
Has the bird been in a home with other animals?
*
Other parrots
Dogs
Cats
Unknown
Other
Other:
Please give a full description of other animals tht this parrot has been around and their reactions and interactions:
Does this parrot have strong dislikes?
*
Vacuum cleaner
Blenders
None
Unknown
Other
Other:
Does this parrot mimic, talk, or know any words?
*
Yes
No
Mimics sounds
Just cries out loud
Swears
Unknown
Other
Other:
If he or she swears, mimics any sounds, or speaks any words/sentences; please enter them below:
Does your parrot sing songs?
*
Yes
No
Whistles
Unknown
Other
What songs does your parrot sing or whistle?
Does your parrot like music?
*
Yes
No
Unknown
Please list the different types of music that this parrot is accustomed to:
Does the parrot like television?
*
Yes
No
Unknown
What types of programs do you or the parrot watch?
*
Nature channel
Cartoons
News
Game shows
Sitcoms
Radio
Other
Other
What kind of toys does your parrot like?
*
Soft wood
Hard wood
Plastic
Cloth
Metal bells or toys
Unknown
Other
Other
Has the parrot lived in a household with smokers?
*
Yes
No
Never
We smoke in the back room
Vape
Unknown
Do you burn candles in the house?
*
Yes
No
Sometimes
Other
Other:
Has the parrot been outside the home on overnight trips?
*
Yes
No
Short car rides
Outside the cage
Camping
Travels often with a companion
Unknown
Other
Other:
Does your parrot get car sick?
*
Yes
No
Unknown
How does the parrot react to outsiders?
*
Suspicious and shy at first
Loves everybody
Will step up onto anyone
Fine, very sociable
May take a while to earn trust before you can handle
Stands off and may nip or bite
Unknown
Does your parrot like baths?
*
Hates all water
Yes
No
In the shower with me
Spray bottle
In the sink
Unknown
How do you bathe your parrot?
*
Parrot takes a bath in its cage in the water bowl
My parrot never showers
Mist or spray bottle
In the shower on a perch
In the shower on my arm
Kitchen sink
On perch in or while on cage
Outside on perch with hose or spray bottle
Unknown
How often does your parrot bathe?
*
Daily
Once per week
Twice per week
Once per month
Rarely bathes
Unknown
*Important* Describe your parrot's current daily diet, including brands of seed mix or pellets:
*
Does your parrot like table/human food? If yes, what foods?
*
What are your parrot's favorite fruits/veggies?
*
Served warm or cold?
*
Nuts - Shelled or Unshelled?
*
Special favorite treats?
*
Favorite cooked foods:
*
Will your parrot stay on a perch or cage top if left alone?
*
Yes
No
Unknown
Do you need a padlock or link for your parrot's cage?
*
Yes
No
Unknown
Will the parrot come out of the cage on your hand?
*
Yes
No
With a training stick
Unknown
Other
Other:
Does your parrot know the step up command?
*
Yes
No
With a training stick
Gloves
Unknown
If no, how does your parrot get in and out of the cage?
What time does your parrot wake up?
*
6am to 8am
8am to 10am
10am to noon
Unknown
What time does your parrot go to bed?
*
6pm to 8pm
8pm to 10pm
10pm to midnight
After midnight
Nightowl
Unknown
Daily morning routine:
*
Daily afternoon routine:
*
Daily evening routine:
*
Do you cover the cage at night:
*
Yes
No
Unknown
Describe the type of blanket you use?
What type of laundry detergent do you use? (if scented, name brand)
Can you donate the parrot's security blanket?
*
Yes
No
Unknown
Type and number of perches in the cage:
*
In what room was the cage located?
*
The the cage area, how was the traffic flow?
*
Low, 1 or 2 humans
Medium, 3 to 5 humans
High, 5 or more humans
Other animals
Unknown
In the cage area, were there other animals roaming free?
*
Yes
No
Unknown
What types of roaming animals?
How many hours per day is your parrot left alone?
*
2 to 4 hours
6 to 8 hours
10 to 12 hours
Unknown
How many hours per day is your parrots left outside the cage?
*
Is your parrot allowed to freely roam when outside the cage?
*
Yes
No
Unknow
Is your parrot supervised when outside the cage?
*
Yes
No
Unknown
Has your parrot ever bonded with another parrot or animal?
*
Yes
No
Unknown
What breed and sex or other bird was your parrot bonded to?
Is your parrot stick trained?
*
Yes
No
Unknown
Is your parrot afraid of a training stick?
*
Yes
No
Unknown
Does your parrot pluck or overpreen?
*
Yes
No
Partially feather plucked
Unknown
Do you know the triggers for this type of behavior?
What steps have you taken to modify this behavior?
Is your parrot used to being toweled?
*
Yes
No
Unknown
Has your parrot been allowed on shoulders?
*
Yes
No
Unknown
Do you know who your parrot's prior owners were?
*
Yes
No
Unknown
Do you know how long the previous owners had your parrot?
Do you know why they needed to rehome your parrot to you?
Why do you need to place your parrot up for adoption?
*
Is there anything else you would like the new owner to know about your parrot?
*
Would you like to be in contact with the new adopter?
*
Yes
No
Undecided
Yes, via email only
Yes, both email and phone
Items staying with your parrot (toys, perches, cages, accessories):
*
Cage size, description, and dimensions:
*
What is the exact location of each bowl? Where is the water bowl, seed or pellet bowl, treat bowl, etc. located
*
If possible, please upload a photo of the cage(s)
Click or drag a file to this area to upload.
If possible, please upload a photo of your parrot with the cage(s)
Click or drag a file to this area to upload.
If possible, please upload any additional photos of your parrot
Click or drag files to this area to upload.
You can upload up to 5 files.
If possible, please upload photos of the property or home
Click or drag files to this area to upload.
You can upload up to 5 files.
I/we understand that the placement of our parrot is a serious matter.
*
Confirm
I/ we understand that there is a suggested donation contribution requested for relinquishment into this program. The donation contributions are determined by several factors depending upon the needs of various sizes of parrot. This will ensure the quality care that a relinquished parrot requires. Some parrots take years to find their new vetted forever homes. Please review and check the appropriate box for the size of parrot below. * We will call you within 24 hours of receipt of your form.
*
Confirm
I/we understand that there is an suggested relinquishment donation for all placements. Please check the appropriate box for your size of parrot:
*
Large Parrots (Macaw and Large Cockatoos) (Macaws 650.00) (Large Cockatoos 600.00) *Total reservation donation per parrot
Medium Parrots ( Electus and Medium Cockatoos 550.00, African Greys 500.00) *Total reservation donation per parrot
Medium/ Small Parrots (Amazons 500.00, Pionus or Indian Ringneck 400.00) *Total reservation donation per parrot
All Other Small Parrots (Conures or Quakers 350.00, Cockatiels 200.00, Parakeets 150.00)
Flocks of 3 to 5 or more, Small Birds (Finches - Parakeets 75.00 per bird +/- depending on size of flock, special needs, and conditions)
* Additional Donation See Below
Additional Amount
100.00
500.00
1000.00
Other
Your contribution is a tax deductible donation.
Name
*
First
Last
Signature
Submit
Page load link
Go to Top
