Cat Intake Questionnaire Date Date Format: MM slash DD slash YYYY Name* First Last Phone*Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Select One:* Stray Owner Surrender How many cats/kittens are you surrendering?*Cats's Name and Gender (If more than one, please list all.)Approximate Age:Please select all that apply: Spayed/Neutered Microchipped Declawed Reason for surrender? (Please explain.)*How long have you been caring for this cat?*Where did you acquire this cat?*Has this cat been seen by a veterinarian? Yes No Veterinarian's Name:Please list and explain any health issues we need to be aware of:Does this cat use their litter box? If no, please explain.Where does this cat primarily live? Indoors Outdoors Indoor/Outdoor Please select all that apply: Good with children Good with dogs Good with other cats Prefers to be an only pet Unknown (stray) Please select all that apply (personality): Lap cat Prefers to be alone Playful Shy or nervous What else would you like for us to know about this cat?
