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Cat Surrender Form
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*
" indicates required fields
Step
1
of
3
33%
About You (The Owner)
Name
*
Owner (You) First Name:
Owner (You) Last Name:
Your Email Address:
*
Your Phone Number:
*
Where are you located? (ex: Redmond, Bend, Madras, etc.):
*
About Your Pet
Animal's Name:
Animal's Age:
Animal's Breed:
*
Animal's Sex:
*
Female
Female Spayed
Male
Male Neutered
Unknown
Please upload a picture of your animal:
Max. file size: 256 MB.
How long have you had your cat? How did you acquire this cat?
*
Why are you surrendering your cat?
*
Does your cat have any medical or behavior problems?
*
Yes
No
Please explain your cat's medical or behavior problems:
*
Is your cat on any medications or special diet?
*
Is your cat up to date on vaccinations?
*
Yes
No
Unknown
Can you provide medical records?
What is your cat's primary veterinary clinic?
Is your cat spayed and neutered?
*
Yes
No
Unknown
Has your cat been tested for FIV/FeLV within the past year?
*
Yes
No
Unknown
What were the results for the FIV/FeLV?
*
If we were able to provide you with a solution for the issue that is causing you to surrender your cat (free food, low cost veterinary care, training, or behavioral help), would you consider keeping your cat?
*
Yes
No
Please explain more about your answer to the previous question:
*
Pet Profile
What is your cat's personality like? Check all that apply:
*
Active
Playful
Affectionate
Friendly
Shy
Independent
Fearful
Destructive
Vocal
Other (explain below)
Explain your cat's "other" personality:
Is your cat indoor or outdoor?
*
Indoor
Outdoor
Both
Where does your cat sleep?
*
What does your cat eat? (check all that apply):
Dry Food
Canned Food
Homemade Diet
Raw Diet
Prescription
Other (explain below)
Explain your cat's "other" food:
*
Please check all that your cat has lived with:
Cats
Dogs
Small Mammals (rabbits, guinea pigs, etc)
Birds
Fish
Children
Teenagers
Adult Men
Adult Women
Senior Citizens
Please explain in detail your cat's behavior towards any of the listed animals and/or humans above:
Has your cat ever bitten a person?
Yes
No
Please explain when it occurred and the circumstances of the bite:
*
Has your cat bitten and broken skin on a person within the last 10 days?
*
Yes
No
Has your cat ever bitten another animal?
*
Yes
No
Please explain when it occurred and the circumstances of the bite:
Is your cat sensitive when being handled (feet, ears, head, etc)?
*
Yes
No
Does your cat have any issues using a litter box?
*
Yes
No
Please explain your cat's issues using a litter box:
*
Please explain how your cat reacts to treatment/medical care at a veterinary clinic:
*
What is your cat afraid of?
*
What does your cat do when uncomfortable? )e: run away, hiss, swat, sratch, bite, other, etc. Please explain:
*
If applicable, please list any other additional information about your cat that will be important for BrightSide to know:
*
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