Feline Surrender Profile - ebhs. ??A library Middle of the road A carnival . ... Does your cat ever eliminate ... When was the last time your cat saw a veterinarian ...

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  • Feline Surrender Profile

    Feline Profile The following questionnaire provides Elmbrook Humane Society (EBHS) with more information about your cat in order to learn more about his/her

    behavior. Because your cat is likely to behave in similar ways in his/her new home, this information helps us find the most suitable match for your cat. Your open and honest answers are necessary and appreciated.

    Surrender Reason Please describe why you are applying to surrender your cat to EBHS.

    ________________________________________________________________________________________________________________________________________________________________________

    If help could be provided with remedying the reason for surrender, would you be open to keeping your cat? Yes No Possibly

    Were you referred by a person or business? Yes No If yes, who: _____________________________________________________________________________

    Owner Information

    Name (first and last) Date application submitted

    Street address City State Zip code

    Phone/Type (primary) Phone/Type (secondary) Email

    Animal Information

    Name Breed Age Sex Altered Color Declawed?

    Y N

    Y N

    If your cat is declawed, is he/she: Declawed in the front only Four paw declawed

    If your cat is declawed, was this done: As a kitten As an adult Already declawed when acquired

    Where did you get your cat from? EBHS Friend/Relatives Newspaper/Online Found/Stray Breeder Pet store

    Another Shelter/Rescue:____________________________________________ Other (please describe): _____________________________________________________________

    How long have you had your cat? _____________________________________ Including yours, how many homes has your cat had? ______________________________

    Household Information

    Please list all people currently living in your home:

    Name (first and last) Age Name (first and last) Age

    0-7 yrs 7-12 12-18 18+ 0-7 yrs 7-12 12-18 18+

    0-7 yrs 7-12 12-18 18+ 0-7 yrs 7-12 12-18 18+

    0-7 yrs 7-12 12-18 18+ 0-7 yrs 7-12 12-18 18+

    0-7 yrs 7-12 12-18 18+ 0-7 yrs 7-12 12-18 18+

  • If children are living in your home, how does your cat react to the children?

    Friendly/Social Shy/Scared Tolerant/Indifferent Other (please describe): _____________________________________________________________

    Please list all companion animals that your cat has lived with or is currently living with:

    Name Breed Age Sex Altered Declawed Still in home

    Y N Y N Y N

    Y N Y N Y N

    Y N Y N Y N

    Y N Y N Y N

    Y N Y N Y N

    No other animals in the household

    If you have other pets in your household, did your cat get along with them? Yes No (please explain)___________________________________________ Sometimes (please explain):_________________________________________________________

    What would you consider the activity level in your household to be like? A library Middle of the road A carnival

    Typical Behaviors/Tendencies:

    Does your cat ever eliminate outside of the litterbox? Yes No If yes, how often ____________________________________________________________

    If yes, does your cat urinate only, defecate only, or both? Urinate Defecate Both

    If yes, how long has your cat been inappropriately eliminating? ______________________________________________________________________________________________________

    If yes, where does your cat eliminate other than the litterbox?

    _______________________________________________________________________________________________________

    If yes, what have you tried to help correct the inappropriate elimination? __________________________________________________________________________________________

    If yes, have you been to the vet to rule out infection or any underlying healthy issues? Yes No

    What type of litter does your cat prefer? Clay Clumping Shavings Pellets Other ____________________________________________________

    What brand of litter does your cat prefer? ____________________________________________________

    How many litterboxes do you have? _________________________ Where are they located? _________________________________________________________________________

    What type of litterbox does your cat prefer? Covered Uncovered Other ____________________________________________________________________________

    Does your cat ever spend anytime outside? Yes No If yes, please describe________________________________________________________________________________

    Where does your cat spend most of his/her time? Inside the house, free roam Inside the house, confined to a specific area _____________________________

    Outside, free roam Other (please specify) ____________________________________________________________________________________________________________

    How long is your cat left alone during the day? Never left alone 1-3 hours 4-8 hours 9-12 hours 12+ hours

    Where does your cat usually sleep at night? ______________________________________________________________________________________________________________

    Is your cat allowed on the furniture? Yes No If yes, is there anywhere your cat does not have access to jumping on? __________________________________

    What are your cats bad habits, if any? ____________________________________________________________________________________________________________________________

    Does your cat have a scratching post? Yes No If yes, how many/what type? ______________________________________________________________________________

    If no, does your cat have an allotted space/item he/she can use to scratch? Yes No If yes, what/where? ____________________________________________________

  • Is your cat talkative? Yes No Does your cat like to purr? Yes No

    If your cat had a career what would it be? __________________________________________________________ Why? _______________________________________________________

    How does your cat usually react when you or another family member does the following (please place an x in all that apply)?

    Never tried Enjoys Allows Afraid Hisses/Growls Scratches Bites None

    Bathe

    Brush

    Hold

    Hug

    Pick up

    How does your cat usually behave toward the following (please place an x in all that apply)?

    People your cat knows Never encounter Friendly Afraid Hisses/Growls Scratches Bites None Men

    Women

    Children

    Unfamiliar People Never encounter Friendly Afraid Hisses/Growls Scratches Bites None Men

    Women

    Children

    Animals your cat knows Never encounter Friendly Afraid Hisses/Growls Scratches Bites None Dogs

    Cats

    Unfamiliar Animals Never encounter Friendly Afraid Hisses/Growls Scratches Bites None Dogs

    Cats

    If your cat has bit, did the bite break skin? Yes No Was the bite reported? Yes No Did the bite require medical attention? Yes No

    Please explain circumstances of the bite(s) __________________________________________________________________________________________________________________________

    What toys does your cat like to play with? Balls Mice Wand Laser String None Other _____________________________________________

    What games does your cat like? Fetch Hunt Chase Climb None Other ____________________________________________________________________

    What is your cats favorite thing to do? ___________________________________________________________________________________________________________________________

    Describe your cats activity level: Very active Moderately active Couch Potato

    Is your cat afraid of anything? Yes No If yes, please describe _________________________________________________________________________________________

    Does your cat exhibit any anxiety over anything? Yes No If yes, please describe __________________________________________________________________

    What are your cats top 3 best qualities?

    1._______________________________________________________2.________________________________________________________3.____________________________________________________

    Would you describe your cat as: More social More independent

    On a scale from 1-10 how would you rate your cats level of affection? 1-not affectionate 2 3 4 5 6 7 8 9 10-super affectionate

  • Medical History

    Does your cat see a veterinarian at least once a year? Yes No

    When was the last time your cat saw a veterinarian? __________________________________________________________________________________________________________

    If yes, please specify the veterinarian name and contact information:

    Veterinarian Name ______________________________________________________________ Contact Info ______________________________________________________________________

    Is your cat current on his/her vaccines? Yes No

    How does your cat usually behave while at the vet for the following procedures (please place an x in all that apply)?

    Hisses/Growls Scratches Bites None Unknown

    Wellness exam

    Restraint

    Vaccination

    Nail trim

    Blood draw

    Ear cleaning

    Does your cat have any past or present medical conditions? Yes No If yes, please describe _______________________________________________________

    Is your cat currently on any medication or special diet? Yes No If yes, please describe _______________________________________________________

    What type of food does your cat eat? Kibble Canned Raw Other ________________________________ Brand______________________________________

    Is your cat a good eater? Yes No Please explain ________________________________________________________________________________________________

    How often is your cat fed per day? Once Twice More than twice Free-fed (food out all day) Other ____________________________________________

    *I certify that the above information is accurate and truthful to the best of my knowledge.

    ____________________________________________________ ___________________

    Signature Date

    OFFICE USE ONLY

    Staff Member Name Initials Date

    Feline Profile

    Please describe why you are applying to surrender your cat to EBHS: If help could be provided with remedying the reason for surrender would you be open to keeping your cat: Were you referred by a person or business: If yes who: Name first and lastRow1: Date application submittedRow1: Street addressRow1: CityRow1: StateRow1: Zip codeRow1: PhoneType primaryRow1: PhoneType secondaryRow1: EmailRow1: NameRow1: BreedRow1: AgeRow1: SexRow1: Y: N: ColorY N: Y_2: N_2: Declawed in the front only: Four paw declawed: As a kitten: As an adult: Already declawed when acquired: EBHS: FriendRelatives: NewspaperOnline: FoundStray: Breeder: Pet store: undefined: undefined_2: Another ShelterRescue: Other please describe: How long have you had your cat: Including yours how many homes has your cat had: Name first and lastRow1_2: 07 yrs: 712: 1218: 18: Name first and lastRow1_3: 07 yrs_2: 712_2: 1218_2: 18_2: Name first and lastRow2: 07 yrs_3: 712_3: 1218_3: 18_3: Name first and lastRow2_2: 07 yrs_4: 712_4: 1218_4: 18_4: Name first and lastRow3: 07 yrs_5: 712_5: 1218_5: 18_5: Name first and lastRow3_2: 07 yrs_6: 712_6: 1218_6: 18_6: Name first and lastRow4: 07 yrs_7: 712_7: 1218_7: 18_7: Name first and lastRow4_2: 07 yrs_8: 712_8: 1218_8: 18_8: If children are living in your home how does your cat react to the children: FriendlySocial: ShyScared: TolerantIndifferent: Other please describe_2: NameRow1_2: BreedRow1_2: AgeRow1_2: SexRow1_2: Y_3: N_3: Y_4: N_4: Y_5: N_5: NameRow2: BreedRow2: AgeRow2: SexRow2: Y_6: N_6: Y_7: N_7: Y_8: N_8: NameRow3: BreedRow3: AgeRow3: SexRow3: Y_9: N_9: Y_10: N_10: Y_11: N_11: NameRow4: BreedRow4: AgeRow4: SexRow4: Y_12: N_12: Y_13: N_13: Y_14: N_14: NameRow5: BreedRow5: AgeRow5: SexRow5: Y_15: N_15: Y_16: N_16: Y_17: N_17: No other animals in the household: Yes_3: undefined_3: undefined_4: No please explain: Sometimes please explain: A library: Middle of the road: A carnival: Does your cat ever eliminate outside of the litterbox: If yes how often: Urinate: Defecate: Both: If yes how long has your cat been inappropriately eliminating: If yes where does your cat eliminate other than the litterbox: If yes what have you tried to help correct the inappropriate elimination: If yes have you been to the vet to rule out infection or any underlying healthy issues: Clay: Clumping: Shavings: Pellets: undefined_5: Other: What brand of litter does your cat prefer: How many litterboxes do you have: Where are they located: Covered: Uncovered: undefined_6: Other_2: Yes_6: undefined_7: No If yes please describe: Where does your cat spend most of hisher time: Outside free roam: Inside the house free roam: undefined_8: Inside the house confined to a specific area: Other please specify: Never left alone: 13 hours: 48 hours: 912 hours: 12 hours: Where does your cat usually sleep at night: Yes_7: undefined_9: No If yes is there anywhere your cat does not have access to jumping on: What are your cats bad habits if any: Yes_8: undefined_10: No If yes how manywhat type: Yes_9: undefined_11: No If yes whatwhere: Is your cat talkative: If your cat had a career what would it be: Why: Never triedBathe: EnjoysBathe: AllowsBathe: AfraidBathe: HissesGrowlsBathe: ScratchesBathe: BitesBathe: NoneBathe: Never triedBrush: EnjoysBrush: AllowsBrush: AfraidBrush: HissesGrowlsBrush: ScratchesBrush: BitesBrush: NoneBrush: Never triedHold: EnjoysHold: AllowsHold: AfraidHold: HissesGrowlsHold: ScratchesHold: BitesHold: NoneHold: Never triedHug: EnjoysHug: AllowsHug: AfraidHug: HissesGrowlsHug: ScratchesHug: BitesHug: NoneHug: Never triedPick up: EnjoysPick up: AllowsPick up: AfraidPick up: HissesGrowlsPick up: ScratchesPick up: BitesPick up: NonePick up: Never encounterMen: FriendlyMen: AfraidMen: HissesGrowlsMen: ScratchesMen: BitesMen: NoneMen: Never encounterWomen: FriendlyWomen: AfraidWomen: HissesGrowlsWomen: ScratchesWomen: BitesWomen: NoneWomen: Never encounterChildren: FriendlyChildren: AfraidChildren: HissesGrowlsChildren: ScratchesChildren: BitesChildren: NoneChildren: Never encounterMen_2: FriendlyMen_2: AfraidMen_2: HissesGrowlsMen_2: ScratchesMen_2: BitesMen_2: NoneMen_2: Never encounterWomen_2: FriendlyWomen_2: AfraidWomen_2: HissesGrowlsWomen_2: ScratchesWomen_2: BitesWomen_2: NoneWomen_2: Never encounterChildren_2: FriendlyChildren_2: AfraidChildren_2: HissesGrowlsChildren_2: ScratchesChildren_2: BitesChildren_2: NoneChildren_2: Never encounterDogs: FriendlyDogs: AfraidDogs: HissesGrowlsDogs: ScratchesDogs: BitesDogs: NoneDogs: Never encounterCats: FriendlyCats: AfraidCats: HissesGrowlsCats: ScratchesCats: BitesCats: NoneCats: Never encounterDogs_2: FriendlyDogs_2: AfraidDogs_2: HissesGrowlsDogs_2: ScratchesDogs_2: BitesDogs_2: NoneDogs_2: Never encounterCats_2: FriendlyCats_2: AfraidCats_2: HissesGrowlsCats_2: ScratchesCats_2: BitesCats_2: NoneCats_2: If your cat has bit did the bite break skin: Please explain circumstances of the bites: Balls: Mice: Wand: Laser: String: None: undefined_12: Other_3: Fetch: Hunt: Chase: Climb: None_2: undefined_13: Other_4: What is your cats favorite thing to do: Very active: Moderately active: Couch Potato: Is your cat afraid of anything: If yes please describe: Does your cat exhibit any anxiety over anything: If yes please describe_2: 1: 2: 3: More social: More independent: On a scale from 110 how would you rate your cats level of affection: Does your cat see a veterinarian at least once a year: When was the last time your cat saw a veterinarian: Veterinarian Name: Contact Info: Is your cat current on hisher vaccines: HissesGrowlsWellness exam: ScratchesWellness exam: BitesWellness exam: NoneWellness exam: UnknownWellness exam: HissesGrowlsRestraint: ScratchesRestraint: BitesRestraint: NoneRestraint: UnknownRestraint: HissesGrowlsVaccination: ScratchesVaccination: BitesVaccination: NoneVaccination: UnknownVaccination: HissesGrowlsNail trim: ScratchesNail trim: BitesNail trim: NoneNail trim: UnknownNail trim: HissesGrowlsBlood draw: ScratchesBlood draw: BitesBlood draw: NoneBlood draw: UnknownBlood draw: HissesGrowlsEar cleaning: ScratchesEar cleaning: BitesEar cleaning: NoneEar cleaning: UnknownEar cleaning: Yes_19: If yes please describe_3: Yes_20: undefined_14: If yes please describe_4: Kibble: Canned: Raw: undefined_15: Other_5: Brand: Is your cat a good eater: Please explain: Once: Twice: More than twice: Freefed food out all day: undefined_16: Other_6: Date: Staff Member NameRow1: InitialsRow1: DateRow1:

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