Survey - Cat Surrender Profile - Wisconsin Humane Society

General Information:

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Name:

First Required	Last Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

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Phone Number: Required

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Gender: Required

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Date of Birth: Required

Date of Birth:

Remember me.

An appointment is requested so we're better prepared for your animal's arrival. To schedule a surrender appointment, please complete this form and call the campus nearest you:

Milwaukee Campus: 414-431-6102
Racine Campus: 262-554-6699
Ozaukee Campus: 262-377-7580
Green Bay Campus: 920-469-3111
Door County Campus: 920-746-1111

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Question - Required - Do you have a surrender appointment scheduled at one of our campuses?

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Question - Required - If "yes" to the above question, at which campus did you schedule the appointment?

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Question - Required - Cat's Name:

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Question - Required - Breed or Markings:

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Question - Required - Color:

Question - Not Required - Age:

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Question - Required - Sex:

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Question - Required - Spayed or Neutered:

Question - Not Required - Declawed:

Question - Not Required - If declawed, at what age?

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Question - Required - Where did you get your cat?

Question - Not Required - If other, please specify:

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Question - Required - Why are you surrendering your cat to the Humane Society? (Be specific)

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - How long have you owned your cat?

Question - Not Required - What are two things you like the most about your cat's behavior?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Have there been recent changes in the home? Example: moving, new pet, new baby

(Maximum response 255 chars, approx. 5 rows of text)

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Question - Required - Has your cat ever bitten anyone?

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Question - Required - Did the bite break the skin?

Question - Not Required - How many times has your cat bitten?

Question - Not Required - Explain the circumstances:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Does your cat use his or her litterbox?

Question - Not Required - Does your cat:

Question - Not Required - If sometimes, how often does your cat make mistakes?

Question - Not Required - What surfaces and places does your cat choose to use instead of the litterbox?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - How many litterboxes can your cat access?

Question - Not Required - How often is the litterbox(es) scooped out?

Question - Not Required - How often are the litterboxes completely emptied and washed?

Question - Not Required - What kind of litterbox does your cat use?

Question - Not Required - If other, please describe:

Question - Not Required - What kind of litter do you provide for your cat?

Question - Not Required - If other, please describe:

Question - Not Required - Is the litter:

Question - Not Required - Where are the litterboxes located? (If you live in a multi-level home or apartment please indicate on which floor the boxes were kept, as well as location.)

(Maximum response 255 chars, approx. 5 rows of text)

Does your cat:

Question - Not Required - Scratch furniture:

Question - Not Required - Chew plants:

Question - Not Required - Scratch on doors or cabinets

Question - Not Required - Chew personal items (clothing, shoes, etc.)

Question - Not Required - Does your cat use a scratching post?

Question - Not Required - What type of post does he/she use?

Question - Not Required - How affectionate is your cat?

Question - Not Required - Does your cat like to be picked up?

Question - Not Required - Does he/she struggle to get down when picked up?

Question - Not Required - When you sit down does your cat jump onto your lap?

Question - Not Required - Does your cat tell you to stop petting him/her?

Question - Not Required - If yes, how does he/she tell you to stop?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Does your cat prefer to play:

Question - Not Required - What is his/hers favorite toy(s)?

Question - Not Required - When playing does your cat nibble on hands?

Question - Not Required - Does your cat ever play by pouncing on your feet?

Question - Not Required - Does your cat live with other cats?

Question - Not Required - If yes, how many, what age and what sex?

Does your cat:

Question - Not Required - Spend time and/or play with the cat(s):

Question - Not Required - Avoid the cat(s):

Question - Not Required - Actively fight with the cat(s):

Question - Not Required - Does your cat live with dogs?

Question - Not Required - If yes, how many?

Does your cat:

Question - Not Required - Spend time and/or play with the dog(s):

Question - Not Required - Avoid the dog(s):

Question - Not Required - Actively fight with the dog(s):

Question - Not Required - Number of children in the home:

Question - Not Required - Ages:

Does your cat:

Question - Not Required - Spend time and/or play with children:

Question - Not Required - Avoid children:

Question - Not Required - Hide from children:

Question - Not Required - When guests come over does your cat:

Question - Not Required - How comfortable is your cat with brushing:

Question - Not Required - How comfortable is your cat with clipping nails?

Question - Not Required - Does your cat have any medical problems or require medication?

Question - Not Required - If yes, please explain:

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - Is your cat current on all vaccinations?

Question - Not Required - Has your cat been tested for Feline Leukemia?

Question - Not Required - How does your cat react when being seen by a veterinarian?

(Maximum response 255 chars, approx. 5 rows of text)

Question - Not Required - What, if any, behavioral problems does the cat have?

(Maximum response 255 chars, approx. 5 rows of text)

Wisconsin Humane Society

Cat Surrender Profile

Please Donate!

Milwaukee Campus

Ozaukee Campus

Racine Campus

Door County Campus

Green Bay Campus

Wisconsin Humane Society