Bi-State Wildlife Patient Admission (Admit)
This form is used to track all patients that come in via the Bi-State Wildlife Hotline. Every animal should have a corresponding admit sheet when it comes in. You are welcome to use the paper forms, but you'll have to input the info here at some point.
Your Name *
Permit Holder's Name *
This is the name of the person who is entering this/these animal(s) on their records, under their permit.
Date Admitted
MM
/
DD
/
YYYY
Reunite Attempted?
Finder's Name
Finder's Street Address
Finder's City and State
Finder's County
Finder's Zip Code
Finder's Telephone
Finder's Email Address
How did they hear about us? Who referred them to us?
Did Finder Make a Donation
Clear selection
Donation Type
Clear selection
Amount Donated
Species Admitted *
Quantity Admitted (Female)
Quantity Admitted (Male)
Weights
Enter as weight in grams plus gender. Example: F 63g, M 54g, F 58g
Notes (How was animal found? How is animal wounded? Why was animal admitted? What was animal fed before admission?)
Vaccination/Worming Date
If raccoon, skunk, fox, or coyote: Date of first vaccine and worming. (Should be the same as the admit date, but isn't always.)
MM
/
DD
/
YYYY
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