West Nile Virus Phone Message
Action Needed: ¨ Call back to set pick up plan
¨ No need to call at this time
Your Name: ______Date: ____/_____/201___
Caller’s name:______
Street Address:______
______Zip Code: ______
Phone: (____)______or (____)______
City: ______County: ______
Species: ______How many:___
Pick up plan:
¨ Caller referred to: ______
______
¨ Report recorded, no pick up necessary
¨ We will pick up the bird
Other info:______
¨ Bird picked up on ______by ______
West Nile Virus Phone Message
Action Needed: ¨ Call back to set pick up plan
¨ No need to call at this time
Your Name: ______Date: ____/_____/201___
Caller’s name:______
Street Address:______
______Zip Code: ______
Phone: (____)______or (____)______
City: ______County: ______
Species: ______How many:___
Pick up plan:
¨ Caller referred to: ______
______
¨ Report recorded, no pick up necessary
¨ We will pick up the bird
Other info:______
¨ Bird picked up on ______by ______
West Nile Virus Phone Message
Action Needed: ¨ Call back to set pick up plan
¨ No need to call at this time
Your Name: ______Date: ____/_____/201___
Caller’s name:______
Street Address:______
______Zip Code: ______
Phone: (____)______or (____)______
City: ______County: ______
Species: ______How many:___
Pick up plan:
¨ Caller referred to: ______
______
¨ Report recorded, no pick up necessary
¨ We will pick up the bird
Other info:______
¨ Bird picked up on ______by ______
West Nile Virus Phone Message
Action Needed: ¨ Call back to set pick up plan
¨ No need to call at this time
Your Name: ______Date: ____/_____/201___
Caller’s name:______
Street Address:______
______Zip Code: ______
Phone: (____)______or (____)______
City: ______County: ______
Species: ______How many:___
Pick up plan:
¨ Caller referred to: ______
______
¨ Report recorded, no pick up necessary
¨ We will pick up the bird
Other info:______
¨ Bird picked up on ______by ______