Todays Date:

Your Name:

Phone Number(s):

Physical Address:

Email Address:

Animals Name:

Breed:

Male or Female:

Age:

Spay/Neutered? Y or N

Sent Photo? Y or N If no, please write general physical description here:

Veterinarian:

Referred by:

1. If you are a shelter facility or a foster home answer these questions first then go to number 3 below. If you are not a shelter or foster home, please skip below.
   
2. Describe his/her interaction with the other animals.
   
3. How long has she/he been with you in the rescue center or foster home?
   
4. Does she interact with any other animals during the day on a regular basis?
   
5. Tell me what you know about his/her past.
   
6. Are there other animals in the house? How many and what kind? Please elaborate on the interaction.
   
7. Tell me about its history. How old when you adopted, etc.
   
8. Please list any current medications and/or supplements and current Vet diagnosis/care.
   
9. What are his/her physical symptoms?
   
10. Does she/he have any negative behaviors? And how long have these behaviors been going on?
    
11. Describe his/her personality.
    
12. What does his/her diet consist of? Please tell me brands if possible.
    
13. Have there been any recent emotional changes in the house; new family member; moved; loss of a family member, etc.
    
14. Please tell me your main concern or intention for what you are hoping to accomplish for
    your companion.

“So important are animals to our spiritual lives that we do not merely use animal imagery to
embody religious themes; rather, we discover spiritual values through animals.” - Christopher Manes

To set up an
appointment email:
tammy@blessanimals.com
or call 770-552-9877

Located in Roswell, Georgia

For questions email:
info@blessanimals.com