Wildlife Intake Form

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Todays Date *

MM

DD

YYYY

Date animal was found *

MM

DD

YYYY

Does the animal have any known injuries?

Yes

No

Unknown

Did you attempt to give food or water? *

Yes

No

Approximate age of animal (Mammal)

Newborn

Juvenile

Adult

Approximate age of animal (Bird)

Hatchling

Nestling

Fledgling

Juvenile

Adult

Condition of Animal

Great

Good

Fair

Poor

Bad

DOA