Permanent Resident Record – Rescue Management System

Your Name *

Pet Tag Number *

Pet Name *

Date of Pet admission *

Rescue Type *

Self Rescue
Ambulance Rescue
NA

Informed the reporter as the pet will be Sarvoham's permanent resident? *

Yes
No
NA

Pet Video *

Click or drag files to this area to upload. You can upload up to 5 files.

Kindly upload 360° of pet’s video including face and side ways. Minimum 30 seconds video should be uploaded.

Animal *

Dog (Above 1 year)
Puppy (Less than 1 year)

Age of the animal *

Breed? *

Animal History? *

Gender? *

Male
Female

Sterilization? *

Yes- Done
No- Not Done

1. GENERAL APPEARANCE

Mentation *

Bright, Alert, and Responsive
Quiet, Alert, and Responsive
Dull
Others

a) Vital Signs

Breathing Problem? *

Yes
No

c) EYES Problem

Ulcers? *

Left Eye
Right Eye
Both Eyes
NA

Cataract? *

Left Eye
Right Eye
Both Eyes
NA

d) NOSE / NARES Problem *

Yes
No
Others
NA

e) ORAL CAVITY Problem

f) EAR Problem *

Tilted head
Shaking head
Others
NA

g) NECK Problem *

Stiffness
Pain
Others
NA

h) THORAX Problem *

Yes
No

i) LEGS Problem

Fully bearing weight *

Yes
No

k) GENITALS Problem *

Tumor
Mass
Others
NA

l) TAIL Problem *

Yes
No
Others

n) SPINE INJURY- Score *

0= No Sensation
1= Very little
2= Impaired
3= Normal

Proprioception (Only choose problem) *

Left Front Leg
Right Front Leg
Left Hind Leg
Right Hind Leg

Score? *

Sensation (Only choose problem) *

Left Front Leg
Right Front Leg
Left Hind Leg
Right Hind Leg

Score? *

Stiffness of front legs *

Yes
No
Others
NA

Visible spine-deformation *

Yes
No
Others
NA

Laterally Recumbent *

Yes
No
Others
NA

Sitting *

Normal
Abnormal
Others

o) FRACTURE Location (If no, please mention 'NA') *

p) TUMOR Location (If no, please mention 'NA') *

Any Comments?