EXTERNAL Cat Intake Request

ANIMAL CONCERN CUMBRIA (Please note that becuase of time restrictions, we will make thre attempts to contact you after which your enquiry will be archived. Please ensure your phone and email details are correct and working).

Mr Mrs Ms Mx Dr Rev Title *

First Names of Main Owner (or person caring for or reporting a stray) *

Surname of main owner (or person caring for or reporting a stray) *

Address where the cat lives *

Town or area *

Your Postcode *

Your email address

Confirm email

Home or landline number *

Mobile number (first mobile) *

Second mobile if you have one

NoYes Are you the legal owner of the cat *

NoYes Is the cat microchipped? *

If unsure, select "NO"

NoYes If microchipped, is the chip currently registered to you? *

NoYes Is there anyone else who may consider themseves the legal owner? *

If yes, please provide the name, address and details of that person

Police investigation RSPCA or SSPCA Improvement Notice Council enforcement Court order Is the cat subject to any of the following (can click more than one)? *

If yes, provide details

NoYes Has this cat been imported from abroad or travelled abroad *

If yes, please give details, dates, and Pet Passport or Health Certificate

How long have you had or been feeding this cat *

In the case of a stray, how long have you been aware of the animal being around)

Pet Shop Breeder Gumtree or similar Facebook Rescue Centre Stray Kennels Found it recently Found it a while back and decided to keep it My pet had babies Family or friend Bereavement Other Where did you get your cat from *

Please select as many as apply. if the cat came from another rescue, please contact them first and only submit the form to us once you have done this,

Why are you rehoming your cat (if this is a stray, use this box to give further information) *

What is the cat's name *

How old is the cat (please give an estimate if not known) (please specify if weeks, months or years) *

In the case of a stray - please say if it is a kitten, adult etc.

Male Female Don't know Can't get close enough to check. Is the cat male or female *

NoYes Does the cat appear to have the end of one of its ears flattened off (tipped)?

Short haired cat Long haired fluffy cat Pedigree cat - short haired Pedigree cat - long haired What type is your cat *

Black Tabby Ginger Tortoiseshell Grey Brown Cream White What colours are present on the cat's fur? Pick each colour that applies *

Please give a bit more description of your cat *

Yes No Don't Know Is the animal neutered (or spayed) *

If you know it, please enter the approximate date when your pet (if female) finished her last season (heat)

NoYes If the pet is not neutered, are you able to organise neutering before they come into our care

If the animal is chipped and you have the accurate number, please add it fully

How long ago was your animal last seen by a vet *

If your pet has been under vet care, we will need you to instruct the vet who last saw the animal to share the medical history with us.

Name, address and phone number of the veterinary practice who last saw your pet

If you indicated above that the animal had seen a vet

Please give a brief description of any known medical history of your pet *

What brand of food do you feed the animal, and how many times a day *

You may be asked to provide 14 days' food of that brand if your animal comes into our care. This is to enable us to transition or maintain their food to avoid diarrhoea.

Please give details of any allergies the animal has to food or any other products

(This could include food, any flea or worm products, anything in the environment, any allergies that have been tested etc)

How long is the cat left for? *

NoYes Is your pet normally allowed on furniture? *

Please also mention, for example if they jump on furniture they are not meant to.

Pet's own bed Sofa or chairs Under furniture Our bed or beds Children's Outside Various places with another pet Don't know Where does the animal normally sleep? *

Please select as many as apply

NoYes Do you consider the animal to be toilet trained (clean indoors)? *

If you need to give more detail you can do so at the end of the form

Garden In the house (anywhere In the house - Certain rooms Litter Tray Other Where does your pet toilet *

Please select as many as apply

Calm Lively Nervous Hides Friendly Friendly with strangers Aggressive with strangers Does their own thing and totters around Hides a lot Likes some of the people in the house but not others How the animal behaves at home *

Adult male Adult female Adult non-binary One family or couple A group of flatmates or housemates No kids Kids up to 7 Kids age 7 to 12 Kids over 12 Mostly the house is empty Please select who lives in the house *

Please select as many as apply - If you have anything additional to add, you can do so in the notes at the end of the form

What happened when strangers visit the house or knock at the front door *

Please describe what normally happens

House Flat Bungalow HMO Hotel or B&B Has a garden does not have a garden Allotment or similar Business premises The current address where the pet lives is *

Please select as many as apply

If the animal goes in the garden, how do they behave *

NoYes Has the animal either bitten or badly scratched a person before *

More questions to follow. It is important to be truthful. A yes response will not automatically mean we are unable to help.

My cat has bitten badly My cat has scratched badly Please select all of the following which apply *

Thank you for answering all the above - is there anything else important you need to tell us *

Fixing an urgent medical issue Neutering or spaying Support from our team with general advice Support to ensure that the animal, if a stray, is genuinely lost before I keep it No other help would apply Would you keep the cat if we provided.... *

You can choose more than one (refers to above)

I have read and understood the intake process and privacy policy. *

Photo of your pet or the animal Second photo of pet if you have one

THIS FORM IS STORED AWAY FROM OUR WEBSITE AND THEREFORE DOES NOT LOOK THE SAME. WE CURRENTLY HOLD FORMS FOR THREE MONTHS ONLY AFTER WHICH YOU WILL NEED TO CONTACT US AGAIN. WE ARE CURRENTLY REVISING OUR PROCESSES AND DATA MANAGEMENT WITH THE AIM OF BEING FASTER AND BETTER AT ACKNOWLEDGING ENQUIRIES