Shares Volunteer Name* First Last Phone*Email* Today's Date* MM slash DD slash YYYY Foster Animal Name(s)* For which CHS location are you fostering?* Newington, 701 Russell Road Waterford, 169 Old Colchester Road (Quaker Hill) Westport, 455 Post Road East What type of pet(s) are you fostering?* Canine(s) Feline(s) Small animal(s)-(rabbit, Guinea pig, etc.) Since your last checkup, has/have your foster animal(s) experienced any vomiting? Yes No Since your last checkup, has/have your foster animal(s) experienced any loss of appetite? Yes No Since your last checkup, has/have your foster animal(s) experienced any sneezing? Yes No Since your last checkup, has/have your foster animal(s) experienced any lethargy? Yes No Since your last checkup, has/have your foster animal(s) experienced any loss of fur? Yes No Since your last checkup, has/have your foster animal(s) experienced any diarrhea? Yes No Since your last checkup, has/have your foster animal(s) experienced any loss of weight? Yes No Since your last checkup, has/have your foster animal(s) experienced any coughing? Yes No Since your last checkup, has/have your foster animal(s) experienced any limping? Yes No Since your last checkup, has/have your foster animal(s) experienced any dirty ears? Yes No Since your last checkup, has/have your foster animal(s) experienced any blood in stool? Yes No Since your last checkup, has/have your foster animal(s) experienced any failure to gain weight? Yes No Since your last checkup, has/have your foster animal(s) experienced any runny noses? Yes No Since your last checkup, has/have your foster animal(s) experienced any itchiness? Yes No Since your last checkup, has/have your foster animal(s) experienced any constipation? Yes No Since your last checkup, has/have your foster animal(s) experienced any dehydration? Yes No Since your last checkup, has/have your foster animal(s) experienced any eye discharge? Yes No Since your last checkup, has/have your foster animal(s) experienced any rashes? Yes No If you answered yes to any of the questions above, please explain your answers.Has/have your foster cat(s) had any of the following behavioral concerns? (Check all that apply) Stool outside the litter box Urine outside the litter box Destructive behavior Aggression Fearfulness Separation Anxiety Has/have your foster dog(s) had any of the following behavioral concerns? (Check all that apply) Stool in the house Urine in the house Destructive behavior Aggression Fearfulness Separation Anxiety Has/have your foster small animal(s) had any of the following behavioral concerns? (Check all that apply) Stool outside the litter box Urine outside the litter box Destructive behavior Aggression Fearfulness Separation Anxiety Biting humans Attacking other animals What is the energy level of your foster pet(s)? High Medium Low If you responded to the behavioral question(s) above, please explain your answers. Shares
