Wildlife Rehabilitation Intake Form PDF Details

When an injured or orphaned wild animal is brought to a wildlife rehabilitation center, the staff needs to gather information about the animal as soon as possible. This information can help determine the best course of action for rehabilitating the animal. The wildlife rehabilitation intake form is used to collect this information. The form asks for basic information about the animal, such as its name, age, and species. It also asks for details about how the animal was found and its injuries or symptoms. This information is important in order to provide the best possible care for the animal. Thanks for reading!

QuestionAnswer
Form NameWildlife Rehabilitation Intake Form
Form Length1 pages
Fillable?Yes
Fillable fields11
Avg. time to fill out2 min 31 sec
Other nameswildlife rehabilitator intake form, intake form for wildlife rehabilitation, wildlife rehabilitation intake forms, wildlife intake forms il

Form Preview Example

WILDLIFE REHABILITATION 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 non-profit, licensed wildlife veterinary hospital in the Chicago 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 mandate these animals be euthanized. If the animal can be released, once healed we will release it into a correct and safe habitat.

We are only able to care for this animal with your help. Without your donation to help, we cannot sufficiency care for this animal.

NAME

PHONE

 

DATE

 

 

 

 

ADDRESS

CITY

STATE

ZIP

 

 

 

WHERE DID YOU FIND THE ANIMAL? (ADDRESS, IF POSSIBLE)

 

WHEN?

 

 

 

 

DO YOU KNOW HOW IT BECAME INJURED?

 

 

 

 

 

 

 

WHAT, IF ANYTHING, HAVE YOU FED IT?

 

 

 

No, I will not support the care of this animal with a donation

Yes, I will support the care of this animal with a donation

THANK YOU FOR THIS TAX DEDUCTIBLE GIFT OF AMOUNT $

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

THANK YOU FOR YOUR SUPPORT!

OFFICE USE ONLY

DATE

SPECIES

OUTCOME

 

 

 

815-929-9393 P | 815-929-0059 F

711 Almar Pkwy., Bourbonnais IL 60914

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