Animal Discharge Record Log Form
Complete this log to record details of each animal's discharge. This form is for general record-keeping and does not collect sensitive health information.
Animal Name
*
Animal ID or Tag Number
*
Species
*
Please Select
Dog
Cat
Rabbit
Bird
Reptile
Other
Breed or Description
Date of Discharge
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Discharge
*
Please Select
Adoption
Transfer to Rescue
Return to Owner
Foster Placement
Other
Condition at Discharge (non-medical)
Please Select
Active and Alert
Calm
Stressed
Other
Person Responsible for Discharge
*
Discharge Destination or Next Placement
*
Please Select
Adopter
Rescue Organization
Foster Home
Owner
Other
Special Instructions or Notes
Submit Record
Should be Empty: