*
Question - Required -
Type of animal(s) (select all that apply):
Please make at least 1 selection from the choices below.
Question - Not Required -
Other:
*
Question - Required -
Color:
*
Question - Required -
Approximate breed:
*
Question - Required -
Coat length:
Short
Medium
Long
Question - Not Required -
Animal name, if known
Question - Not Required -
Number of animals:
Question - Not Required -
Size of animals
Question - Not Required -
Skin/Coat Condition:
Question - Not Required -
Other:
Question - Not Required -
Thin (please select from the options below)
Question - Not Required -
Injured (please select from the options below)
Question - Not Required -
Other:
Question - Not Required -
Where is the animal injured?
*
Question - Required -
Shelter:
None
Available
Question - Not Required -
If available, please describe (size, if hay is available for warmth, etc.)
(Maximum response 255 chars, approx. 5 rows of text)
*
Question - Required -
Water:
None
Clean/fresh water
Dirty water
Question - Not Required -
Sanitation:
Feces
Wet/muddy
Trash
Toxic waste
Question - Not Required -
Confinement:
Question - Not Required -
Please describe
(Maximum response 255 chars, approx. 5 rows of text)
Question - Not Required -
Other details, including any other hazards:
(Maximum response 255 chars, approx. 5 rows of text)
*
Question - Required -
Did you personally witness the incident?
Yes
No
Question - Not Required -
When did you witness the incident?
*
Question - Required -
When did you last see the animal?
Question - Not Required -
Where is the animal currently located? (Please give us an address.)
(Maximum response 255 chars, approx. 5 rows of text)
Question - Not Required -
Vehicle description (if any associated with the suspect or animal(s)):
Car
Truck
Van
Question - Not Required -
Vehicle color:
Question - Not Required -
Vehicle make & model:
Question - Not Required -
License plate:
Please provide contact information below. HSHV does not disclose your information to anyone. It is not required, but it is helpful in case we have further questions or need more information.