HEAVEN ON EARTH AVIAN ACRES by Cherane Pefley    |     home       
BLUE HEADED MACAW QUESTIONNAIRE

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Potential Acquisition Name of Interest
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Thank you for taking the time to visit my site. This site was developed for you

If you would like more information on a special bird please use my mail form below.

Please provide information that I may answer your questions.

First and Last Name
Address
Address 2
City State Zip
Email
LAND LINE Phone Number ONLY
Species of Birds Your Interested:
Please hold CTRL Key to make multiple selections.
inquiry, choose other.
Comments.


Potential Acquisition

Are you interested ito praticipate n captivebred Blue Headed Macaws program?
Complete this Form.
Thank you,
Cherane Pefley


1. History of ownership of birds, years and species, breeder, rescue or/and pet owner.


2. Do you have birds in your household today?
Yes
No

3. Do you have other pets in the home where you will keep your new avian pet?
Yes
No
a. If answered, Yes, what types of pets?

b. If you answered, "Yes," to Questions #2 or #3 above, please list below names of species


4. Have you had birds die in your home or aviary?
Yes
No
a. Did you have a necropsy and histopathology?
Yes
No
b. How many birds have died in your aviary?

c. Do you have copies of these necropsy and histopathology reports?
Yes
No

5. Do you have an diplomat avian veterinarian?
Yes
No

6. Name and location of your avian vet?


7. Do you have children?
Yes
No
a. If yes," What are there ages?


8. Any smokers in the household?
Yes
No

9. What cage and environment do you plan for your Hyacinth Macaw?


10. Is someone home during most of the day?
Yes
No

11. Do you broker birds (have you bought birds cheap and resold them for any reasons)
Yes
No

12. Do you rescue birds?
Yes
No
a .Rescue birds from pet stores?
Yes
No
b. Rescue from breeders?
Yes
No
c. Rescue from family members?
Yes
No

13. Do you maintain or board any birds from others in your household?
Yes
No
a. If so, how many?


14. Do you have Avian certification or closed facility to the general public
Yes
No

15. When did you make your last bird purchased?


16. Give name of identification source (i.e. band or microchip)


17. May I get written permission from you to contact professionals for reference regarding your purchase?
Yes
No

18. Do you still have that bird (if not, please supply documents to what happened to that bird)
Yes
No

19. How many birdbreeders, birdstores , birdowners have you visited the last year?


20. When was your last aviary vet check or vet check to your facility?


21. Can I get a full report of that visit and tests?
Yes
No

22. Have you studied about the species your interested in purchasing?
Yes
No

23. Do you have an area for quarantine outside your home?
Yes
No

24. Are you a avian vet tech?
Yes
No
a. Avian Veterinarian?
Yes
No
b. History of working in a Aviary or Zoo environment?
Yes
No
c. Yes to 24.b, please give history?


25. Reason for wanting this specie?


26. Would you rewrite your will to accommodate the needs of this purchased pet, for future ownership, beyond your demise?
Yes
No

27. Who, other than you, shall be handling and/or caring for your new avian pet?


28. What is the name of the Avian Veterinarian you would use?


29. How much time do you plan to expend to play with, and/or train your new avian pet?


30. I shall be providing you with an dietary schedule. Shall you buy all of the required ingredients prior to the arrival of your new avian pet?
Yes
No

31. Who, other than yourself, at your home, shall be designated as care giver, during your absence from the residence?


32. Can you supply me with the type of carrier you have for your new additional pet bird?.
Yes
No

33. Have you made a plan to cover any emergency, maintenance, and general costs for your new family member?


34. Are you planning a vacation or time away from the new bird within six months after purchase?
Yes
No

35. Are you a United States Citizen?
Yes
No

34. Are you 18 years or older?
Yes
No

General Comments (if you need consulting, please go to a qualified avian veterinarian)