Owner Surrender Questionnaire Name * First Name Last Name Phone * (###) ### #### Email * Preferred method of communications * Phone Email Pet's name Species of pet * Dog Cat Rabbit Other How long have you owned the pet? Pet's sex Unneutered Male Neutered Male Unspayed Female Spayed Female Is your pet up-to-date on vaccinations? * Yes No If yes, what clinic did you use? Does your pet have any of the following? * Allergies Hot Spots Anxiety No health conditions Please elaborate on any conditions. Is your pet house trained or litter box trained? Yes No Describe the energy level of your pet. How does your pet deal with children? Has your pet lived with other pets? Yes No If yes, what kind? How did they do? Describe your pets personality in three words. Will you be including any supplies? (Enclosure. leash/collar, food/, etc.) * Why are you surrendering you pet? Please be as detailed as possible . * Please describe any behavior issues (bites, inappropriate urinating, etc). Has this animal been involved in an animal control or police investigations? Yes No I'm not sure Thank you!
