Brown Rescue Team Member Medical Care Request

1. Rescue Dog Information

Rescue dog's name *

This menu is for Brown Rescue Team members to request medical care for dogs in their rescue and care. Available to Brown Rescue Team members onlyand your information below must have a name and phone number that match the Brown Rescue Team member registryin order for your request to be submitted.

2. Applicant Information

Full Name * Mobile Number *

3. Symptoms and Medical Request

Please describe the symptoms and what type of medical care is needed * [Required] I agree to the collection and use of personal information. (Items collected: name, contact information, medical care request details / Purpose: medical care submission and guidance / Retention: 1 year from submission date)

🏥 Brown Rescue Team Member Medical Care Request