COLUMBUS HUMANE SOCIETY, INC.

INFORMATION SHEET FOR RESCUED ANIMALS

Date of Rescue __________________ Name____________________ Sex M/F Age____

Description of animal______________________________________________________

Personality ______________________________________________________________

Fostered by ______________________________________________________________

Medical History:

Veterinarian__________________________

First Shots - Date ______________________

Ear Mites  - Date ______________________

Worming – Date _______________________

Bathing – Date ________________________

Other Medicines:

Type ____________________ Prescribed for ______________________

Rabies Shot – Date ________________ Rabies Tag Number _________________

Spay/Neuter:

        Veterinarian ____________________ Date ____________________

Additional Medical Issues: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Details of Rescue ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Adopter:

        Name_________________________________ Phone ____________________

        Address _________________________________________________________

Date of Adoption ______________________