Animal Listing Form

AnimalSavers' Companion Animal Listing Form

Name:
Address:
City:
Zip Code:
Home Phone Number: ( )
Work Phone Number: ( )
Cell Phone Number: ( )
E-Mail Address:

Pet's Name:

Type of Animal:

Sex:
Male Female

Neutered or spayed?
Yes No

Current on shots?
Yes No

If so, which shots?
Required Vaccines:
(Proof of these shots is necessary.)
Dogs only:
Rabies? DHLPP?(distemper, parvo, etc.)
Cats only: FVRCP? (upper respiratory, distemper, etc.)
Optional vaccines.
Dogs only: Bordatella?Heartworm 6 month vaccine?
Cats only: Feline Leukemia? Rabies? Ringworm? Feline Aids?

Is your cat Aids/Leukemia Tested?
Yes No Not Applicable
If yes, test results:
FELV (leukemia) positive FELV (leukemia) negative
FIV (AIDS) positive FIV (AIDS) negative

Date of Test:
Has your cat been exposed to any new cats since testing?
Yes No
Has your cat been outdoors since s/he was tested?
Indoor only pet Outdoor only pet Indoor/Outdoor pet

What commands does your dog respond to?
Sit Stay Come Down Heel Off Leave It No

What circumstances are compelling you to re-home your pet?