Wisconsin and Ozaukee Humane Societies: Survey

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OHS Lost Animal Report

Please complete the following information:

Name:

First Required	Middle Required	Last Required

Email: Required

Street 1: Required

Street 2:

City/State/ZIP:

City Required	StateRequired	ZIPRequired

Country:

Phone Number: Required

Yes, I would like to receive e-mail from Wisconsin and Ozaukee Humane Societies

Email Format:

Yes, I would like to receive postal mail from Wisconsin and Ozaukee Humane Societies

Remember me.

*2.

What date was your animal lost?

Month

Day

Year

*3.

Where was your animal lost?

If your animal was not lost at your home, please enter a detailed description of the area, including address and zip code of the nearest populated area. (If you're unsure of the zip code, you can go to www.usps.com to do a search by address.)

Animal's Name:

*6.

Type of Animal:
Please make 1 selections from the choices below.

	Dog
	Cat
	Rabbit
	Guinea Pig
	Ferret
	Rat
	Gerbil
	Hamster
	Mouse
	Bird
	Reptile
	Amphibian
	Exotic
	Other

*7.

What is the gender of your animal?
Male
Female
Unknown

*8.

Animal's Age:

*9.

Primary Breed:

10.

Secondary Breed (Please note here if your dog is a purebred):

11.

Approximate weight:

12.

Build:

*13.

Primary Color:

14.

Secondary Color:

15.

Other Colors:

	Black
	Blue Black
	Charcoal
	Ebony
	Grey
	Lynx
	Seal
	Silver
	Silver Black
	Smoke
	Blue
	Lavendar
	Lilac
	Shaded Blue Cream Cameo
	Beige
	Brindle
	Brown
	Butterscotch
	Chestnut
	Chocolate
	Golden
	Mustard
	Sandy
	Tan
	Taupe
	Yellow
	Bronze
	Copper
	Mahogany
	Orange
	Red
	Rust
	Cream
	White
	Green
	Apricot
	Blond
	Buff
	Fawn
	Liver
	Wheaten
	Sable

*16.

Coloring Pattern:

*17.

Coat Type:

*18.

Tail:

*19.

Ears:

*20.

Eye Color:

*21.

Collar Type:
Please make at least 1 selections from the choices below.

	Bandana
	Canvas
	Electronic
	Elizabethan (Pinch)
	Flea
	Harness
	Leather
	Nylon
	Plastic
	Spiked
	Studded
	Wire
	Choke
	None
	Other

22.

Collar Color:

	Black
	Blue
	Brown
	Clear
	Green
	Multi
	Orange
	Pink
	Purple
	Red
	Silver
	Tan
	White
	Yellow

23.

Are there any other distinctive markings on you animal that would help us identify him/her?

24.

Are there any personality traits or mannerisms that would help us identify him/her?

*25.

Is you animal microchipped?

26.

If yes, please supply the manufacturer and number.

(Maximum response 255 chars, approx. 5 rows of text)

*27.

Is your dog wearing a rabies tag?

28.

If yes, please provide the rabies tag number and veterinarian who issued it.

(Maximum response 255 chars, approx. 5 rows of text)

*29.

Is your animal wearing any city, town or village license tags?

30.

If yes, please list the municpality and number of the license tag.

(Maximum response 255 chars, approx. 5 rows of text)

*31.

Is your animal wearing any other tags?

32.

Please provide all information that is contained on any additional tags your animal is wearing.

*33.

What would you say your animal's personality is like around strangers?

*34.

What advice would you give to the person finding your animal? (Ex: Lucky answers to his name. Sally is on medication, it's urgent to get her back home.) Provide any information that you feel would help.

Do you have a picture of your animal? It will help us find your animal! Please email your photo to lost@wihumane.org.