Intake Request Form
$$TITLE$$
First Name
*
Enter your first name.
Last Name
*
Enter your last name.
Your Address
*
City
*
State
*
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
Home Phone Number
Mobile Phone Number
*
Email Address
*
Number of cats in need of help
*
1
2
3
4
5+
Address where cat(s) found
*
Are you providing food and/or shelter?
*
No
Yes
How long have you been caring for the cat(s)?
Less than 30 days
60+ days
Is the cat(s) located somewhere safe? (Barn, shed, enclosed porch, etc)?
*
No
Yes
The cat (Please check all that apply):
*
Can be touched
Can be picked up
Stands within reaching distance
Runs when approached
Unknown
Please provide a description of the cat(s) needing help (ear tipped, color, fur length, adult, kitten, etc):
*
Does the cat(s) appear to be sick, injured, or pregnant?
*
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No
Injured
Pregnant
Sick
Have you contacted your local shelter/animal control?
*
No
Yes
When did you contact them and what was the outcome?
Has the cat(s) been scanned for a microchip?
*
No
Yes
Have you checked with neighbors to see if this is someone's pet?
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No
Yes
Have you created a found AD on RI Lost Pets?
*
No
Yes
If provided with the tools and instructions, are you able to help with trapping?
*
No
Yes
Are you able to provide food and shelter if the cat(s) cannot be socialized and have to be returned after spay/neuter?
*
No
Yes
Is there anything else we should know about the cat(s)?
Please upload an image, if available
Please upload an image, if available
By signing this intake request, I agree to the following: All statements made on this request are truthful; I have made no false statements with regard to the cat(s) I'm seeking help for and any other statements made on this request.
*
No
Yes
Electronic Signature
*