MADACC Referral Form MADACC Referral Form This form should be used in cases where animals are not in imminent danger or conditions are not extreme and seizure may not be in the best interest of the animal. Owners will be given education/resources to better care for their animals and followed up with to ensure compliance. Should a visit post intervention reveal that the animal(s)' condition(s) have not improved, referring Officer will be notified. MADACC will provide officer with notification of the conditions we observed and the assistance that we provided. Date Type of Animal Dog Cat Other Owner Name Owner Address Owner Phone Number Name of Police Officer/Enforcement Agent requesting referral Name of Agency Municipality Contact Phone Number for Officer - Use work cell phone only - providing district main number will void request processing. Contact info will not be shared or used for any other purpose Email for Officer making request Type of Assistance Needed Inadequate Shelter - request will be sent to proper agency. Husbandry - poor cleanliness or living conditions - request will be sent to proper agency. Lack of food or water or inadequate access to food/water - MADACC can provide food/water dishes. No Shelter at all - will be sent to proper agency License not current - MADACC will work to get animals compliant with owner. Health - animal in need of medical care - MADACC can refer owner to place for care at low cost. Other - if not listed use field below to describe - MADACC will refer to proper agency or handle if able. Other Assistance Description Notes - Any other details MADACC should be aware of? If you are human, leave this field blank. Submit
