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2. 
3. Feline Surrender Questionnaire

   No one knows and loves your cat the way you do!  In order to find the most appropriate home for your cat, please complete the following form.    

   Please note: Submitting this questionnaire online is NOT a confirmation of an appointment. To schedule an appointment to surrender an animal, please call the shelter during business hours at (859) 356-7400 to speak with a staff member.

8. Cat Name:*
9. Cat Age:*
10. Sex:*

    1. Male
    2. Female
12. Owner First Name:*
13. Owner Last Name*
15. Address*
17. City*
18. State*
19. Zip Code*
21. Phone Number*
22. Email Address
24. Reason for Surrender: *
26. How long have you had this pet?*
27. Where did you get this pet?*
29. Spayed/Neutered?*

    1. Yes
    2. No
    3. Unknown
30. Microchipped?*

    1. Yes
    2. No
    3. Unknown
31. Up-to-date on vaccinations?*

    1. Yes
    2. No
32. Do you have the paperwork?*

    1. Yes
    2. No
34. Veterinarian:
35. Last Visit:
    Last Visit:
37. Please list any past or present injuries, treatments, allergies, or other medical history:*
39. Is your cat currently on any medications?*

    1. Yes
    2. No
40. If yes, please list:*
42. Has your pet ever been involved in a bite incident?*

    A bite incident is qualified by any incident where an animals' tooth or teeth break skin on a human or other animal.

    1. To a human
    2. To another animal
    3. Neither
43. If yes, date the incident occurred: *
    If yes, date the incident occurred:
45. Describe the bite incident:*
47. How would you describe your cat’s living situation?*

    1. Indoor only
    2. Outdoor only
    3. Mostly indoors
    4. Mostly outdoors
    5. Other
48. If "other", please explain:*
50. Has the cat lived with:*

    1. Cats
    2. Dogs
    3. Children
51. For children, what ages?*
53. Would you recommend your cat live with cats, dogs, or children in the future? Why or why not?*
55. How would you describe your cat’s litter box use?*

    1. Always uses the litter box, no problems
    2. Urinates outside of the litter box
    3. Defecates outside of the litter box
    4. Sprays on walls/furniture
    5. Other
56. If other, please explain:*
58. If your cat has issues using the litter box, how often does this occur?*

    1. Rarely
    2. Occasionally
    3. All the time
59. When did these issues start?*
61. Does your cat do any of the following?*

    Check all that apply

    1. Jump on counters
    2. Scratch furniture

    1. Climb curtains
    2. Bite when playing
63. Does your cat like to play with toys?*

    1. Yes
    2. No
64. If yes, what kind?*
66. What are your cat’s favorite activities or objects?*
68. What does the cat dislike or fear?*
70. Check all of the following that describe your cat:*

    1. Very active
    2. Friendly
    3. Separation anxiety
    4. Couch potato
    5. Shy

    1. Talkative
    2. Quiet
    3. Playful
    4. Affectionate
    5. Fearful

    1. Independent
    2. Mischievous
    3. Clever
    4. Always at your side
72. Any additional information that will help us place your cat in the best home for their needs?*
Leave This Blank:


74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

* indicates a required field