Surrendered Misc. Pet Information
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- Alicia Lee
- 5 years ago
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1 Surrendered Misc. Pet Information Animal Code: Pet Name: Spayed/Neutered? Y N I want to be notified if the Placer SPCA is unable to place this animal for adoption. (There is a $25 non-refundable fee for this service) I understand that I must respond or redeem within 24 hours of this notice and will only be called at the numbers I provide on the Animal Receipt. (Please Initial) Counseled On Notification By: Please Check The Behaviors That Might Apply To This Pet & Complete the following questionnaire: Outgoing Fearful Independent Sedate Chews on plants Submissive Gentle Slow to adjust Comes when called Dominant Relaxed Snappy Pushy Sensitive to noise Playful Destructive Anxious Friendly Talkative Attacks/Bites people Shy Affectionate Plays rough Escape oriented Has this pet bitten or seriously scratched anyone (broken skin) in the last 15 days? Yes No If yes, please explain: Does your pet have any special needs? Yes No If yes, please describe: How many people in your family? Children s ages: Why are you giving up this pet? Why did you get this pet? Companion for myself Companion for another family member Unwanted Gift Companion for another pet Another family member got the pet Other: Where did you get this pet? How long ago? History of previous ownership: 2
2 Housing Information Please check all that apply Is this pet: Indoor Outdoor How has this pet been housed? Aquarium-size: Hutch-size: Wire cage-explain: Plastic-explain: Other-explain: Free access of: Home Yard Other: Feeding Information Please check all that apply What brand / type of food does this pet eat? What amount is fed? How often? Where is this pet fed? Does this pet have any favorite treats? Yes No If yes, please describe: Would you describe this pet as a picky eater? Yes No If yes, please describe: Exercise and Play Information Please check all that apply In a 24-hour day how long was this pet left alone at any given time? < 4 hours 4-8 hours 8-12 hours > 12 hours Does this pet enjoy being handled? Yes No Please describe what kind of handling this pet does like: Please describe what kind of handling this pet doesn t like: During an average day how many hours total is this pet handled? Never 1-2 hours 2-4 hours 4-8 hours 8-10 hours Other: Is this pet s activity level: Low energy Middle of the road Extremely active Is this pet most active: Daytime Night time Both 3
3 Behavioral Information Please check all that apply This pet has been in the company of: Adults & Small Children Adults & Older Children Adults Only Not interested in people Dogs Cats Other Does this pet have a preference for: Men Women Children Animals: Please list any additional information on the daily routines for feeding, playing, etc.: What do you enjoy the most about this pet? What do you enjoy the least about this pet? Please describe the ideal home you would like for this pet: Please add any additional information that you feel would be helpful for us or a new owner to know about this pet (this will help us make the best possible match with a new home): This pet is overprotective of: Family Its food/toys Own property Please explain: 4
4 Does this pet have a tendency to snap or bite? Yes No If yes, please explain: Does your pet have any likes or dislikes that a new owner would want to know about? Yes No If yes, please describe: Is there anything else we should know about this pet? Litter Box Information Please check all that apply This pet uses the litter box: Consistently Occasionally Never Goes Outside Number of pets in the home that share the litter box: Male: Female: Are they spayed/neutered? Number of litter boxes in the home: Type(s) of litter box: Uncovered Covered Electronic self-scooping litter box Rolling litter box Baby pool Other: Type(s) of litter used: Clay, non-clumping Brand: Scented Unscented Clumping/scoopable Brand: Scented Unscented Crystals/pearls Brand: Sand Shredded newspaper Other: Depth of the litter: 1 2 Inches 2 3 inches 3 4 inches Greater than 4 inches How often do you scoop out the litter boxes? Daily A few times per week Once a week Every couple of weeks When I can t stand the smell When pet stops using it How often do you dump the litter box (empty and replace the litter): Daily A few times per week Once a week Every couple of weeks Once a month Every couple of months When pet stops using it I just add fresh litter as needed What product(s) do you use when cleaning the litter box? (Simple Green, Pine Sol, Bleach, etc.)? Where in the room(s) are the litter boxes located? Near a wall In a corner Under furniture Out in the open Behind furniture In a closet Other: 5
5 Veterinary Information Please check all that apply Name of this pet s veterinarian or clinic: Address: Telephone number: Has this pet had routine veterinary care? Yes No If neutered or spayed, at what age? Where / by whom? If female and not spayed, has she had any litters? Yes How many? No Has this pet had any major health problems? Yes Please explain: No What medications has this pet received or is currently receiving? Medication Date Illness Vet / Clinic Name May we contact your veterinarian? Yes No IF YOU HAVE ANY OTHER ANIMALS IN YOUR HOME, PLEASE COMPLETE THE FOLLOWING FOR EACH PET Pet #1: Dog Cat Other: Age: Sex: Spayed/neutered? How long did this pet live with the incoming pet? How did this pet get along with the incoming pet? Friendly, no fighting Indifferent, ignored each other Did not get along, avoided each other Did not get along, fought with one another Incoming pet picked on Pet #1 Pet #1 picked on incoming pet 6
6 Any additional information: Pet #2: Dog Cat Other: Age: Sex: Spayed/neutered? How long did this pet live with the incoming pet? How did this pet get along with the incoming pet? Friendly, no fighting Indifferent, ignored each other Did not get along, avoided each other Did not get along, fought with one another Incoming pet picked on Pet #2 Pet #2 picked on incoming pet Any additional information: Pet #3: Dog Cat Other: Age: Sex: Spayed/neutered? How long did this pet live with the incoming pet? How did this pet get along with the incoming pet? Friendly, no fighting Indifferent, ignored each other Did not get along, avoided each other Did not get along, fought with one another Incoming pet picked on Pet #3 Pet #3 picked on incoming pet Any additional information: 7
Surrendered Cat Information Date:
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Camp Cypress Dog Retreat
Client Information Form CONTACT INFORMATION Address: City, State Zip: Home Phone: Mobile Phone: Can we text this number? Y N Email: Alternate Contact: Address: City, State Zip: Home Phone: Mobile Phone