Animal Intake

If you have found an animal in need of Help. Please fill out the form below in its entirety. If you do not get a response with in 1 hour of submission. Please contact Melissa @ 714-401-1216. If you have an emergency please contact your local veterinary hospital. If you have an Urgent matter please call the above phone number also for help. For Further instructions on Care, please see the "Emergency Care.htm"

Orphaned Injured Sick Transportation Other:
Full Name:
Email Address:
Street Address:
City, State, Zip:
Daytime Phone:
Evening Phone:
Cell Phone:
How long have you had the animal?
How/Where is the Animal being Kept? (box, bathroom, warm place, etc..)
Referred By? Example: Animal Assistance League, Vet Hospital etc..
Species: example: puppy, kitten, Bird, wildlife etc..Livestock, calves, foals, lambs. etc..
How many in the litter?:
Breed?:
Over all Condition:	Good Fair Poor
Body Temp: Warm to the touch, Cold to the Touch	Warm Cold
Size? Please list both Inches and Grams if possible.	Inches: Grams
Approx. Age?
Eyes Open?	Yes No
Teeth Present?	Yes No
Umbilical Cord Present?	Yes No
Mothers Condition?
Please describe in detail babies description: *Color*, Hair length, Frightful
Any Injuries If Yes, Please Explain:
Are Fleas Present?	Yes No
(Required Field) Yes No	If for some reason "Orphans Only" is unable to help you, Can we please have permission to share this form with other rescue groups for help?
If Yes, Please Type Full Name Will be considered as a Signature:
If you have found Kitten(s), would you be willing for foster them, even for a short time?	Yes No
If yes, Please explain: days, weeks etc..