Bird Personality Profile

Have you already called us about this pet?*

Yes
No

Please provide your hotline number here:*

CHS will not to reply to inquiries without a valid hotline number.

The first step to requesting a pet surrender is to call CHS. Please call 800-452-0114 to start the process.

CONTACT INFORMATION

Reason for Surrender:*

Date*

Name:*

Prefix First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone:*

Secondary Phone:

Email:*

Preferred method of contact:*

Phone
Email

BASIC INFORMATION

Bird's Name:*

Age or DOB:*

Sex:*

Male
Female
Unknown

Was this bird DNA tested?

Yes
No

Breed:

Color/markings:

Are this bird's wings clipped?*

Yes
No

When were they last clipped?

Who last clipped this bird's wings?

Does s/he fly?*

Yes
No

Are you the primary owner?*

Yes
No

Please explain your relationship to the owner:

Does this bird have a band?

Yes
No

Please enter the band number:

How long has this bird been in your care?*

Where did you get this bird?*

If you got this bird from a previous owner, why did they give the bird away?

Please share available details about the previous family:

If you got this bird from another adoption agency, which one?

If you got this bird from another adoption agency, have you notified them that you can no longer keep this pet?

Yes
No

HEALTHCARE

Has this bird ever been to a veterinarian?*

Yes
No

Name of the veterinary hospital or clinic:

Phone number and town for the veterinary hospital or clinic:

Is this bird on any medication or special diet?*

Yes
No

If yes, what medication and/or special food is your pet taking? Why is your pet on this medication? And what are the dosing instructions?

Does this bird have any present or past medical conditions?*

Yes
No

Details:

Has this bird ever plucked feathers?*

Yes
No

Details:

HOUSING AND DIET

What types and brands of food do you feed?*

What are this bird's favorite foods?

What types of treats has s/he been given?

Where does this bird live?*

Indoors-cage
Indoors-free
Outdoors-cage
Other

Describe where this bird lives?*

How does this bird behave in the cage?*

Where is the cage kept?*

Do you cover the cage?*

Yes
No

When is the cage covered?*

Does the bird chew perches?

Yes
No

Details:

Is this bird allowed outside of its cage in the home?*

Yes
No

When out of the cage, does this bird return when called?

Yes
No
Sometimes
Never allowed out of cage

Does the bird chew household items?

Yes
No

Describe:

Where does this bird spend most of their time?*

Does this bird use a flight suit?

Yes
No

Details:

HOUSEHOLD INFORMATION AND SOCIAL BEHAVIOR

How many adults currently live with this bird?*

Please enter a number from 0 to 15.

Do any children live with this bird?*

Yes
No

How many children live with this bird and what are their ages?*

Do any other birds live with this bird?*

Yes
No

Please list any other birds that live with this bird, including species, gender and size. (IE: "Sparky," a large, male conure)*

Does this bird interact with the other bird(s)?*

Yes
No

Details:*

Does this bird react to the other bird(s)?*

Yes
No

Do any dogs live with this bird?*

Yes
No

Please list any dogs that live with this bird, including breeds (or size). (IE: "Riley," a medium, golden retriever)*

Does this bird interact with the dog(s)?*

Yes
No

Details:*

Does this bird react to the dog(s)?*

Yes
No

Do any cats live with this bird?*

Yes
No

Please list any cats that live with this bird.*

Does this bird interact with the cat(s)?*

Yes
No

Details:*

Does this bird react to the cat(s)?*

Yes
No

Do any other animals live with this bird?*

Yes
No

Please list any other animals that live with this bird, including species.*

Does this bird interact with the other animal(s)?*

Yes
No

Details:*

Does this bird react to the other animal(s)?*

Yes
No

How would you describe this bird's personality?*

How does this bird typically respond meeting adults other than family?

How does this bird typically respond meeting children other than family?

Does this bird like to be handled?*

Yes
No

Describe how this bird prefers to be handled?*

What does this bird do if you try to handle him/her?*

Has this bird ever bitten anyone?*

Yes
No

Has this bird bitten people more than once?*

Yes
No

When was the most recent time this bird bit someone?*

Please describe the circumstances of the bite(s).*

Did the bite cause any bruises or scratches?*

Yes
No

Details:*

Did the bite cause any bleeding?*

Yes
No

Details:*

Does this bird talk?*

Yes
No

What words does this bird know?

This bird prefers:*

Men
Women
No preference

Has this bird been boarded?*

Yes
No

Were there any reports given on their behavior during their stay?

What commands does this bird know?

Does this bird perform the above behaviors every time you ask?

Yes, all the time
No

Where does this bird stay when alone?*

When left alone, does this bird display any of the following behaviors? (Check all that apply.)*

Screams
Plucks
Refuses to eat
Breaks out of cage
Destroys furniture/home
None of these
Other

Please describe:

How vocal is this bird?*

Low
Medium
High

Is this bird frightened of anything (IE: fireworks, etc.)?*

Yes
No

What is s/he afraid of?*

What does s/he do when scared?

What are this bird's favorite games and toys?

Please describe how this bird plays:

NOTES

Does this bird have any characteristics or habits we should know about? (IE: scream when you leave,, etc.)*

What is the most important thing for a new owner to know about this bird?*

Please upload a photo of your pet here. Please be sure it does not include any people, just your pet.

Max. file size: 256 MB.

Please upload any veterinary records, vaccine certificates, or other documents for your pet here.

Drop files here or

Max. file size: 256 MB.

To which CHS location would you like to bring your pet?*

Newington, 701 Russell Road
Waterford, 169 Old Colchester Road (Quaker Hill)
Westport, 455 Post Road East

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CONTACT INFORMATION

BASIC INFORMATION

HEALTHCARE

HOUSING AND DIET

HOUSEHOLD INFORMATION AND SOCIAL BEHAVIOR

NOTES

Save Lives Today

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Newington / Offices

Fox Memorial Clinic

Waterford

Westport

Adoptions: 12-4:30 pm daily in Newington, by appointment only in Waterford and Westport

Need an Appointment? Have Questions?

About Us

Education and Outreach

Programs and Services

Resources

Adopt

Volunteer

Donate

Events/Service Projects

Bird Personality Profile

CONTACT INFORMATION

BASIC INFORMATION

HEALTHCARE

HOUSING AND DIET

HOUSEHOLD INFORMATION AND SOCIAL BEHAVIOR

NOTES

Save Lives Today

$25/MONTH

$100

$72

$50

Newington / Offices

Fox Memorial Clinic

Waterford

Westport

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$25_/MONTH