Intake Form - Small Animals

The aim of the Small Animal intake form is to ensure we gather as much information as possible about the animal requiring space in our care

To help us get back to you as quickly as possible with a decision, please provide detailed, honest and accurate information.
Things to know: You’ll be asked to share details of medical history, behaviour, and photos of your animal. If you're looking to rehome more than 1 animal then you will be required to fill out the form for each individual animal. It takes around 10-20 minutes to complete an application for each animal. If you're happy with the above then please continue.
Title *
First Name: *
Last Name: *
Address: *
Town: *
County: *
Postcode: *
Mobile Number: *
Email Address: *
Can we keep in touch? We'd love to send you updates about what’s happening at CDCH, including heart-warming pet stories, expert pet advice, and how you can support our vital work. Simply let us know how you’d like to hear from us: *	Contact me via phone Contact me via email Contact me via both I opt out of keeping in touch
Where did you hear about us? *
We appreciate a minimum donation of £10 towards each small animal we rehome. Can you give a donation? *	Yes, I can give £10 for each pet I can make a small donation I am unable to make a donation at this time
What is the main reason for parting with your pet? *
Are you the registered keeper on the microchip of this pet(s)? *

Owners Name:
Owners Address:
Town:
County:
Postcode:
Owner's Number:
Owner's Email:
If we can help you keep your pet, would you be interested in discussing the options? *
If offered an appointment at CDCH, do you have transport to be able to attend the centre? *
*	Euthanasia Policy* We will never put an animal to sleep to make space for another animal to come into us. Pets who's emotional and physical needs cannot be safeguarded will be assessed, reviewed and necessary steps implemented to improve this. If a pet is found to have an untreatable or serious medical problem(s), or behavioural issues so severe we deem them unsafe to be rehomed, then euthanasia will be considered. Tick the box to say "I understand and agree with your euthanasia policy."
Rehoming more than one pet: If you're looking to rehome more than 1 small animal at this time then you will need to complete an individual form for each animal. If you're looking to rehome more than 1 species you will be required to fill out the relevant species form for each animal.
Tell us about your pet:
Animals Name: *
Did you rehome this animal from CDCH? *
What species is your small animal? *
What age is your pet? *
What colour is your pet? *
What sex is your pet? *
Neuter status of the pet? *
How long have you owned the pet? *
Where did the animal originally come from? *
If rescued, has the previous centre been contacted?
Is the animal microchipped? *
Has this animal ever been seen by a vet? If yes, please name and address the vet practise they're registered with. *
We will now ask you some more questions on your animal's medical and behaviour history. Please answer these questions to the best of your ability and honestly so we can ensure the best help for you and your pet.
Does your animal have a current medical condition, or had one in the past? *
If you have stated that your animal has a medical condition or has previously had one, please provide us with more details of the condition below (e.g. when were they diagnosed, what is the condition called or related to etc?
Is your animal comfortable with both make and females? *
If NO, please state why;
Information on current home life * Use the text box below to describe what your animals current homelife is like. Please provide details of; How many people live in the household? Is it a quiet household or a busy one? Do they live with children? If so, how old? Do they live with other animals of the same species? Do they live with other animals of different species? What sort of area do you live in e.g. rural, urban etc?
Please provide a photo of their current enclosure or accommodation. *
What is your animals behaviour like towards adults they're familiar with? *
What is your animals behaviour like towards children? *
How does your animal behave in their enclosure? *
How does your animal react towards handling? *
Does your animal live with other animals of the same species? *
If YES, how do they interact?
Has your animal ever bitten anyone?
Has your animal ever bitten anyone? *
If YES, what damage was caused?
It's important for us to have as much information as possible about a bite incident so we can try and understand why this behaviour occurred. If you can, please provide us with who was involved, where it happened and what was happening just before, during and after the event;
Does your animal actively avoid people? *
Does your animal do any of the following behaviours? *	Bar biting Over-grooming / Pulling fur Hiding excessively Restlessness / Pacing Escape attempts Has a reduced appetite Appears 'shut down' Shows none of these behaviours
Tell us more about your pets personability and behaviours; *
Upload a clear photo of your pet! (Please note by uploading a photo, you give us permission to use this photo in future) *

End of Form