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Animal Care Request Form

  1. Animal Description

  2. Animal Condition

  3. Does the animal have a skin condition?

    Check all that apply.

  4. What is the physical condition of the animal?

    Check all that apply.

  5. If a resident/vehicle/person is involved with the threat or injury of the animal please list all known information.

  6. Please provide your name and contact phone number. We may need to contact you for more information about your claim.

  7. Leave This Blank:

  8. This field is not part of the form submission.