Initial Medical Intake Form for Foster Pets
ATTENTION! To Be Completed by Foster after Initial Medical Intake Exam. PLEASE INCLUDE: Pictures of Medical Intake Sheet (Adult Intake Sheets are 2 sides, be sure to include BOTH Sides). Please be sure pictures are Clear and in good lighting. We need to be able to see Vaccination Sticker Information. Please make sure Dates Given and Dosages are written on Medical Sheet. ONE FORM PER ANIMAL. Thank you!
Date
-
Month
-
Day
Year
Date
Foster Parent (your name)
*
First Name
Last Name
Email - You will be sent a copy
*
example@example.com
Intake Date
*
-
Month
-
Day
Year
Date animal was Originally Intaked
Medical Intake Date
*
-
Month
-
Day
Year
Date of Initial Medical Intake Exam
What species are you intaking?
*
Cat
Dog
Other
Foster Pet Name
Date of Birth
*
Must Match DOB on Intake Sheet
Breed
*
Male or Female
*
Female
Male
Description (Color or pattern)
*
Current Weight
*
Microchip Number
*
If for any reason they were unable to be microchipped (ie too small, underweight, medical issues...) Please put 'Needs Chip'
Spayed/Neutered
*
Yes
No
Is your foster ready to be posted for Adoption?
*
No, medical hold
No, too young
No, I may foster fail
Yes, my foster is healthy and at least 7 weeks of age
Other
1st Pic of Med Records
*
Browse Files
Medical Intake Sheet and/or vet records
Cancel
of
2nd Pic of Med Records
Browse Files
Medical Sheet Back Side (Adult Dogs)
Cancel
of
Pictures of Medications
Browse Files
Cancel
of
Picture of Rabies Tag if valid
Browse Files
Cancel
of
Picture of Rabies Tag if valid
Browse Files
Cancel
of
First Picture of Pet
*
Browse Files
Current Picture of Pet
Cancel
of
Date Submitted
-
Month
-
Day
Year
Date
Submit
Should be Empty: