Release or Discharge- Pending

Your Name *

Pet Tag Number *

Date of Pet admission *

Rescue Type *

Date & Time of Release (Appointment) *

Date

Time

Can reporter approach the animal? *

Able to give medicine or apply ointment? *

Keeps in home? *

Can feed the animal? *

Area type? *

Was the reporter informed to keep the treatment record safe for future reference of the animal’s treatment? *

If no, why? *

Any prescription handed over? *

If no, why? *

Explained all the treatments done till date? *

If no, why? *

Informed about the diet with schedule? *

If no, why? *

Informed about any pending vaccinations, deworming, ABC, blood test etc? *

If no, why? *

Informed how to keep the pet healthy and safe? *

If no, why? *

Informed to call back for any guidance? *

If no, why? *

Informed all the above details via? *

Release form filled up by veterinarian? *

If no, why? *

Any Comments?