Guardian (Owner) Information First Name *
Last Name *
Street Address 1 *
Street Address 2
City *
State *
ZIP *
Home Phone *
Work Phone
E-mail *
Description of Cat Cat's Name *
Gender * Gender *
Male
Female
Age *
Breed
How long have you owned the cat? *
Where did the cat originally come from? *
What was the cat’s role in your family?
Is the cat declawed? * Is the cat declawed? *
Yes
No
Why are you surrendering your cat to PAWS? *
General Behavior Check the terms that best describe your cat. * Check the terms that best describe your cat. *
Active
Talkative
Friendly
Submissive
Shy
Affectionate
Independent
Dominant
Aggressive
Is the cat afraid of anything? * Is the cat afraid of anything? *
Yes
No
If yes, specify.
Is the cat litter box trained? * Is the cat litter box trained? *
Yes
No
Does the cat sometimes not use the litter box? * Does the cat sometimes not use the litter box? *
Yes
No
Does the cat sometimes urinate inappropriately (pee)? * Does the cat sometimes urinate inappropriately (pee)? *
Yes
No
If yes, does the cat urinate: If yes, does the cat urinate:
Horizontally (on floors, flat surfaces)
Vertically (on walls, side of furniture)
Both
Does the cat sometimes defecate inappropriately (poop)? * Does the cat sometimes defecate inappropriately (poop)? *
Yes
No
If yes, how long has this been going on?
How often does the cat eliminate inappropriately?
Where or on what is the cat eliminating?
Is the cat neutered? * Is the cat neutered? *
Yes
No
Has the cat been checked by a vet recently? * Has the cat been checked by a vet recently? *
Yes
No
Have you changed the litter type? Have you changed the litter type?
Yes
No
Have you moved the location of the litter box? Have you moved the location of the litter box?
Yes
No
Has there been an addition to your family (dog, cat, child)? Has there been an addition to your family (dog, cat, child)?
Yes
No
Has there been a major change in your family (move, marriage, new roommate, death)? Has there been a major change in your family (move, marriage, new roommate, death)?
Yes
No
Is the cat ever destructive? * Is the cat ever destructive? *
Yes
No
If yes, specifically when and to what?
Does the cat ever behave aggressively when touched on certain parts of the body? * Does the cat ever behave aggressively when touched on certain parts of the body? *
Yes
No
If yes, specifically when and to what?
How does the cat respond to being brushed, bathed and having toenails trimmed? * How does the cat respond to being brushed, bathed and having toenails trimmed? *
Enjoys
Tolerates
Dislikes
Has the cat ever bitten anyone? * Has the cat ever bitten anyone? *
Yes
No
If yes, when did the bite(s) occur?
Did it break the skin? Did it break the skin?
Yes
No
How many times has the cat bitten?
What were the circumstances of the bite(s)?
How many hours per day is the cat indoors? *
How many hours per day is the cat outdoors? *
Does the cat have access to a cat door? * Does the cat have access to a cat door? *
Yes
No
How many hours per day is the cat without humans? *
Does the cat have a scratching post? * Does the cat have a scratching post? *
Yes
No
If yes, what kind of post? If yes, what kind of post?
Wood
Rope
Carpet
Cardboard
Other
Does the cat use the scratching post? Does the cat use the scratching post?
Yes
No
Where does the cat sleep? * Where does the cat sleep? *
Indoors
Outdoors
Behavior with Others Has the cat lived with children? * Has the cat lived with children? *
Yes
No
If yes, how recently?
What ages were the children?
How did the cat respond to the children? How did the cat respond to the children?
Plays with
Tolerates
Hides from
Fights with
How did the children play with the cat? How did the children play with the cat?
Fetch
String Toys
Wrestling with hands
Other
Did the children help take care of the cat? Did the children help take care of the cat?
Fed the cat
Slept with the cat
Has the cat lived with other cats? * Has the cat lived with other cats? *
Yes
No
If yes, please indicate the gender and age of each other cat.
What was the cat’s response to the other cat(s)? What was the cat’s response to the other cat(s)?
Plays with
Tolerates
Hides from
Fights with
Has the cat lived with dogs? * Has the cat lived with dogs? *
Yes
No
If yes, please indicate the gender, age, and breed of each dog.
What was the cat’s response to the dog(s)? What was the cat’s response to the dog(s)?
Plays with
Tolerates
Hides from
Fights with
Has the cat lived with any animals other than dogs or cats? * Has the cat lived with any animals other than dogs or cats? *
Yes
No
If yes, please specify what type of animal.
Miscellaneous Does the cat have any chronic medical problems? * Does the cat have any chronic medical problems? *
Yes
No
If yes, please explain in detail.
Is the cat ill, injured, or on any special diet or medications? Please explain.
Where did the cat go for veterinary care? Please provide name, location and phone of clinic. *
Additional comments or information you'd like to share about the cat.
