HSU Pet Intake Form
Today’s
date:______________________ Date found:
________________
Found by:______________________ phone number:___________________________
Location found:__________________________________________________________
Collar: NO
YES:(description)_______________ Tag: NO YES:(info)________________
Description of pet:
Breed____________________ Color_________________________
Unusual markings___________________________________________________
Ears: __________________
Tail:________________________
Gender: M
F Altered?
Y N
Age:__________months or years
Injuries:___________________________________________________________
Listed in Newspaper on (strays only) _______________________
Vaccination History: Rabies “Puppy
Shots” other: __________________
Previous Vets Info: Name: ______________
# ___________________
Good with Kids: Yes/No
dogs: Yes/No
cats: Yes/No
indoor/outdoor pet
Reason for surrendering animal: Stray * Moving * Unable to care for * Aggression
*Other_____________
As a “Thank You” I would like to donate the following to help with the care
of this animal:
___ $25
___ Leash & Collar
___ Kitty Litter & Pan
___ $40
___ Large Bag of Food (Iams,
Science Diet, Purina One)
$___
(enter amount)
___ Cost of Spay/Neuter
___ Kennel or Crate
_____ Cost of medical needs circled below
Humane Societies Basic Costs per Animal
The Humane Society spends
approximately $120-$200 per animal to prepare them for adoption.
Please donate toward the care of this animal and others.
Spay/Neuter: $40-50
Heartworm Test: $15
Leukemia/AIDS: $15
Heartworm Prevention (per month): $6
Flea/tick prevention (per month):$15
Food/treats (per month): $15
Misc. Expenses: $20-$60
These numbers are an estimate.
Many times an animal may require additional medical services that are not
listed on this chart.
I hereby release this pet into the care of the Humane Society of Uvalde.
SIGNATURE
_______________________________
Date: ______________________
Email: ______________________________________
************************FOR VET USE BELOW**************************
Health screening:
Heartworm:
Positive or
Negative
FELV/FIV Test
Positive or
Negative
Fecal:
hook
whip
tape
round
coccidia
Other conditions:____________________________________________________
Foster parent:___________________________________________________________
Adopted to:_____________________________________________________________
Date of adoption:____________________ Amount spent:
$______________________