<p> Animal Intake Form</p><p>Incident: ______Intake Personnel Name: ______Title: ______</p><p>Date: ______Case # ______Animal ID # ______Animal Transport # ______Agency or Team: ______</p><p>Animal Stats Name Species Breed Color/Markings Gender Known ID  Dog  Female  Collar  Cat  Male  ID Tag  Other Altered  License: ______ Yes  Rabies:______ No  Microchip:______ Tattoo:______</p><p>Initial Evaluation Behavior:  Friendly  Shy/Cautious/ Fearful  Aggressive  Biter/Bite Hold</p><p>Animal Health Status:  Emergency Medical  Medical Care Advised  Stable  Pregnant  Deceased</p><p>Medical Exam: Date: ______Veterinarian: ______ Examined  Treatment Sheet Filed</p><p>Final Evaluation Disposition:  Returned to owner  Deceased  Euthanized </p><p> Adopted Name: ______Address: ______Phone: ( ) ______( ) ______</p><p> Transferred Organization: ______Address: ______Contact: ______Phone: ( ) ______( ) ______</p><p>Final Behavioral Evaluation Behavior:  Friendly  Shy/Cautious/ Fearful  Aggressive  Biter/Bite Hold</p><p>Exit Personnel/Evaluator Name: ______Title: ______</p>