Exotic Pet Intake Form
Please complete all fields to help us provide the best care for your exotic animal during intake.
Owner Full Name
*
First Name
Last Name
Owner Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Owner Email Address
example@example.com
Pet Name or Identification
*
Species / Type of Animal
*
Please Select
Bird (e.g., parrot, cockatoo)
Reptile (e.g., snake, lizard, turtle)
Amphibian (e.g., frog, salamander)
Mammal (e.g., ferret, sugar glider, hedgehog)
Fish
Invertebrate (e.g., tarantula, scorpion)
Other
Age of Animal (if known)
Sex of Animal
Male
Female
Unknown
Reason for Intake or Visit
*
Please Select
Owner Surrender
Transfer from Another Facility
Rescue/Stray
Medical Evaluation
Boarding
Other
Arrival/Appointment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Current Health or Care Concerns
Housing, Handling Notes, or Special Instructions
Submit Intake
Should be Empty: