NHS Cat Surrender Form
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Your first and last name *
Your phone number, including area code *
Your address (include city, state, and zip code) *
Your county of residence *
Your email address *
Please indicate the reason(s) for surrender: *
We may have alternatives to help keep your pet in your home OR provide you with information to find him/her a new home without having to enter the shelter. Would any of the following resources help you to keep your pet in the home? Check all that apply: *
Required
Cat's name: *
Cat's age: (specify in years, months, and/or weeks) *
Cat's breed: *
Cat's gender *
Is your cat spayed/neutered? *
Is your cat declawed? *
Is your cat microchipped? *
Where did you get your cat? *
How long have you had your cat? (specify in years, months, etc.)
Including yours, how many homes has your cat had?
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Does your cat like to be picked up? *
Including yourself, please mark which of the following ages of people live in your house? *
Required
What other animals has your cat lived with? *
Required
How many other animals, and what type (dog/cat/critter) currently live with your cat? If none, enter N/A. *
Does your cat get along with other pets in the home? *
If no, is this cat the resident cat or newest addition. Enter N/A if not applicable. *
Would your cat do best as an only cat? Why? *
How does your cat get along with the following *
Friendly
Social
Loves
Fearful
Hisses/Swats
Claws/Bites
Attacks
Hides/Avoids
Unknown
Familiar Men
Familiar Women
Strangers
Babies
Toddlers
Dogs
Other Cats
Where is your cat generally kept? *
On a typical day, how long is your cat alone? *
Where does your cat spend most of his/her time? *
Required
Does your cat display destructive behaviors? *
If yes, please describe or enter N/A. *
Where does your cat sleep at night? *
Does your cat use a scratching post? *
If yes, what type of scratching post does your cat use? *
What are your cat's favorite toys and how does she/he like to play? *
Is there a body part your cat does not like you to touch? *
Required
What, if anything, is your cat afraid of? *
What, if anything, has your cat been aggressive toward? *
How often does your cat hide? *
When hiding, is your cat still eating, drinking, and using the litter box? Enter N/A if not applicable. *
has your cat ever escaped or tried to escape your home? *
Is your cat litter box trained? *
Has your cat ever eliminated outside of the litter box? *
What did your cat do? *
Did you visit a vet when the litter box issue started? *
If yes, was he/she tested for urinary problems? *
If yes, what were the findings/diagnosis? If no, enter N/A *
Please describe the circumstances surrounding your cat eliminating outside of the litter box in detail, or enter N/A. (How many times over the past year has your cat eliminated outside of the litter box? How frequently does this occur? When did the litter box issues start? Are they using the litter box sometimes but eliminating outside of the box other times? Does the cat still go outside of the litter box even when it is clean? Where does the cat eliminate when he/she goes outside the box? Does the cat eliminate in a specific room? Does this happen on a certain surface type? If yes, what kind? Have there been any changes to the environment or health of the pets or people in the home?) *
What type of litter box is your cat used to? *
How many litter boxes are in the home? *
How many cats are in the home sharing litter boxes? *
How often do you clean the litter box? *
Has your cat ever bitten a person? *
Did the most recent bite break skin? *
Please describe the incident, in detail, or enter N/A. (i.e. age of victim, body part bitten, what started the aggressive behavior?) *
How did the bite end? *
What did your cat do immediately following the bite? *
Has the biting been an ongoing behavior? *
Does your cat give warning signs that he/she is going to bite? *
If yes, what are the warning signs? (ears back, hissing, growling, etc.) Enter N/A if not applicable. *
What are you doing when your cat bites (sitting, standing, petting, etc.)? Enter N/A if not applicable. *
Is there any vocalization before or after the bite? *
Has the bite behavior increased in frequency? *
Have there been any changes to the household, including the environment, or routine of the people or pets since the biting started? *
If yes, what were the changes? Enter N/A if not applicable. *
Does your cat bite during play? *
Have there been things in your cat's environment that could cause your cat to bite such as other animals outside or loud noises? *
If yes, what were they? Enter N/A if not applicable *
Please describe any other behavioral issues your cat has. *
Please describe any training methods you have tried to help resolve the behavior issues. *
Has your cat ever been seen by a veterinarian? *
When was this cat last seen by a veterinarian? *
Please provide the veterinarian or clinic's name and phone number. Enter N/A if not applicable. *
Is your cat vaccinated for rabies? *
If yes, please indicate the date of the rabies vaccination and the expiration date. Enter N/A if not applicable. *
Has your cat ever required a special surgery? *
If yes, please describe. Enter N/A if not applicable *
Is your cat on any medication? *
If yes, please list the medications. Enter N/A if not applicable. *
Does your cat have recent or ongoing history with any of the following conditions *
Required
Is there anything else you would like us to know about your cat? *
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