Cat Surrender Questionnaire

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SafeHaven Humane Society receives more requests than we have space to accommodate. Submitting this form does not mean we have agreed to accept your dog or cat. We will contact you to schedule an assessment appointment for an evaluation, which includes a brief behavior and health assessment. If an assessment appointment is offered bring the animal’s medical records or email them prior to the appointment.

Important: Only one animal per form. If you have multiple animals that you wish to surrender they will each need a form submitted. Kittens under 3 months may be on the same form, but make sure to indicate how many there are.

Your Name (first and last)(Required)

Street Address:(Required)

City(Required)

State(Required)

Zip Code(Required)

Your Phone Number(Required)

Your Email Address(Required)

Cat's Name(Required)

Cat's Age or Approximate Age(Required)

Breed or Breeds, if known(Required)

Cat's Approximate Weight(Required)

Cat's Sex(Required)

Male

Female

Unknown

Is your cat spayed/neutered?(Required)

Yes

Unknown

Does your cat have a tattoo?(Required)

Yes

Unknown

If so, where?

Does your cat have a microchip?(Required)

Yes

Unknown

Is your cat declawed?(Required)

Yes

Unknown

How long have you owned this cat?(Required)

Where did you acquire this cat?(Required)

SafeHaven Humane Society

Other Shelter/Rescue (Please specify below)

Found as stray

Breeder/Pet Store

Private party/Courtesy posting

Family or friend

Other shelter or rescue:

If your cat is from another rescue or shelter have you tried returning your cat to them?

Yes

What did the rescue or shelter say?

Has your cat ever bitten a person?(Required)

Yes

Unknown

If yes, did they draw blood?(Required)

Yes

Unknown

Has your cat bitten a person in the last 10 days?(Required)

Yes

Unknown

Has your cat ever bitten another animal?(Required)

Yes

Unknown

If yes, did they draw blood?(Required)

Yes

Unknown

Has your cat bitten another animal in the last 10 days?(Required)

Yes

Unknown

Why are you rehoming this cat?(Required)

If we could help resolve the issue, would you be interested in keeping this cat?(Required)

What would you like new owners to know about this cat?(Required)

Has your cat ever been seen by a veterinarian?(Required)

Yes

Veterinarian seen

How does your cat do at the veterinarian?

Relaxed

Scared

Timid

Aggressive

What food is your cat currently eating?(Required)

Are there any places on your cat's body that they do not like touched? If so, where?(Required)

Does this cat have any known health issues?(Required)

Is your cat currently on any medication?(Required)

Yes

If yes, which medications?

How would you describe your cat most of the time? (check all that apply)(Required)

Affectionate

Playful

Shy with family

Shy with new visitors

Independent

Very active

Not active

What are your cat's favorite things to do? Examples: favorite toys, treats and/or activities, etc.(Required)

Does your cat currently live with any of the following? (check all that apply)(Required)

Large dog(s)

Small dog(s)

Cat(s)

Small animal(s)

Livestock

Children

Would you recommend placing this cat in a home with other cats?(Required)

Yes

Would you recommend placing this cat in a home with dogs?(Required)

Yes

Would you recommend placing this cat in a home with kids?(Required)

Yes

Does your cat have access to a litter box in the house?(Required)

Yes

Does your cat urinate and/or defecate outside the litter box?(Required)

Yes

How many cats share the litter box?(Required)

Please describe you cat's behavior around strangers/ visitors?(Required)

Is there anthing else you want us to know about this cat that would help us care for them and would like adopters to know?

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SafeHaven Humane Society is a 501(c)3 organization.

Our tax-ID number is 93-0676661 and donations are tax-deductible to the extent allowed by law.

Hours

We are currently open 7 days a week:
12:00pm – 5:00pm

Address

32220 Old Hwy 34, Tangent, OR 97389

Contact

(541) 928-2789

info@safehavenhumane.com

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