Auburn University Raptor Center Patient Admission Form - Auburn University College of Veterinary Medicine

Today's Date(Required)

Presented By or Transferred From Information

Name, address and contact information of individual or organization presenting the bird to the Auburn University Raptor Center.

Presenter Organization (if applicable)

Presenter Name(Required)

First Last

Presenter Address(Required)

Street Address Address Line 2 City State ZIP Code

Presenter County(Required)

Presenter Phone(Required)

Presenter Mobile Phone

Presenter Email

Where Found

Location where rescued, collected or acquired form

Date of rescue(Required)

Is the rescuer the same as above?(Required)

Yes

Rescuer Name(Required)

First Last

Rescuer Phone(Required)

Rescuer Mobile Phone

Rescuer Email

Rescuer Location Address

Same as above. If no, enter rescue location including street address, city, county and state in fields below.*

Street Address Address Line 2 City State ZIP Code

Rescuer Location County(Required)

If rescued at your personal address, can the animal be released on the property?(Required)

Yes

Reason for Rescue (please be as specific as possible, i.e., cat/dog, found in road, etc.):(Required)

Have you offered the animal any food or water? If yes, what and when?(Required)

Any other treatments given?(Required)

Do you have a carrier/box that you would like to pick-up?(Required)

Yes

If yes, please request a label from the front desk and write legibly your name and phone number, and place it on the carrier before you leave. **All carriers/boxes must be picked-up within seven days or they will be discarded.

Would you like to be added to our mailing list?

Yes

Triage Hours

By dropping this animal off for admission with the Auburn University Raptor Center, I acknowledge that all raptor intakes will be triaged during the hours of 8 a.m. – 5 p.m. daily. No medical care will be provided outside of these hours.

Birds surrendered to the Auburn University Raptor Center are covered under permits held in accordance with all state and federal permit regulations. The transporter or transferring organization have no rights pertaining to the bird turned over to Auburn University Raptor Center.

Full Name(Required)

By entering your name here, you acknowledge that you have read and understood the triage hours of the Auburn University Raptor Center above.

Wild Bird

I acknowledge that this bird was found in the wild and is not owned or permitted for use by the individual/organization dropping it off. Owned or Permitted birds cannot be dropped off with the Auburn University Raptor Center. Owned or permitted birds can be seen through the Auburn University Vet Clinics Exotic Service. ie. Falconry raptor or Special Possession Educational Permitted.

Full Name(Required)

By entering your name here, you acknowledge that you have read and understood that this bird was found in the wild and is not owned or permitted by yourself or organization. ie. Falconry raptor or Special Possession Educational Permitted.

TRANSFERS FROM ORGANIZATIONS/PERMITTED REHABILITATORS

Food Type/Amount

Treatments Given (including medications)

Exam Findings

List all respiratory and neurological symptoms:

Has patient been tested for HPAI?

Yes

If yes, please list result.

HPAI Results

Has your organization had any positive or suspect cases of HPAI in your facility?

Yes

Please elaborate on any positive or suspect cases of HPAI