Intake Form

The fact that you have taken time to stop and pick up an injured or orphaned wild animal demonstrates a deep commitment and sense of caring on your part and is to be valued and appreciated. It is important you are aware that we feel the same way, which is why we operate the only self-funded licensed wildlife veterinary hospital in this area.

The U.S. Fish and Wildlife Service prohibits individuals from maintaining any wild animal in captivity, even temporarily, without a license. By law, people cannot own the wildlife that exists around them. People (like Dr. Becker) can become licensed to care for injured wildlife, but no one owns these animals. Licensed wildlife rehabilitators are trained to provide the correct housing, food and medical care for native wild animals. If the animal is damaged beyond repair, state and federal regulations state these animals must be euthanized. If the animal can be released, once healed we will release it into a correct and safe habitat.

Name___________________________________________Phone__________________

Your address________________________________________City_____________________

Where did you find the animal?_____________________________________________When?_____________

We feel strongly about caring for all animals (regardless of species). We will donate all of our time, medication, surgical expenses, food and housing costs to help this animal. Will you make a tax-deductible donation to help us continue caring for injured wild animals?

Yes_________    No__________    Amount_________________  Date_________________

Due to the volume of wildlife we receive we cannot call you with progress reports, but you may call us.  __________________________________________________________________________________

Office use only

 

Species____________________________Diagnosis___________________________

Treatment______________________________________________________________

Disposition_______________________Date___________Location________________