Cat Owner Surrender Form

This form is a way for us to get to know you and your animal better. Please answer the following questions honestly and to the best of your ability.

First Name *
Last Name *
Physical Address *
City *
State *
Zipcode *
Email *
Primary Phone *
Secondary Phone
Cat's Name *
Species *
Reason for needing to surrender *
Breed *
Age/birthdate *
Male or Female *
Spayed or Neutered *
Are you this cat's first owner? *
Where did you get this cat from? *
How long ago did you find the cat? *
Has your cat ever bitten a person? *
Was medical attention required?
Were animal control, police, or paramedics involved?
Description of events leading up to bite
Description of person bitten
Did the bite break skin?
Has the cat ever bitten another animal? *
What type of animal?
Was vet attention required?
Was animal control or police involved?
Description of events leading up to the bite
Are there children your cat interacts with regularly? If yes, list their ages *
Does your cat interact well with the children?
Does your cat consistently use the litter box? *
Describe the litterbox issues *
Has your animal seen the vet for the litterbox issues? What was the recommendations if so, or if not - why not? *
Which veterinarian(s) has your cat been to? *
When was the cat last seen by a vet? *
Is the cat currently prescribed any medications or taking any supplements? *
Does the cat have any medical conditions that you are aware of? If so, please describe *
How does the cat do with cats? *
How does the cat do with dogs? *
Do you have any additional information that may help us place your cat in a new home?
Please share a photo of the animal.
Signature *

By signing, I certify that the following information I have given is true and that I am the owner of this cat. I further authorize the investigation of all statements in this application and verify that I am at least 18 years old. Finally, I understand that completing this questionnaire does not guarantee that LCHS will intake this animal.