Small Animal SURRENDER Questionnaire

If you adopted your animal from The Baltimore Humane Society, please call us (410-833-8848, Ext 2) to schedule your return. You do not need to complete this form. Thank you.

I understand that submitting this form is not a guarantee that I will be able to surrender my pet to the Baltimore Humane Society. Intakes are done on a case-by-case basis and can only be made after we evaluate your pet. We will contact you with the next steps.

What type of small animal do you need to surrender?

Where did you originally obtain your small animal?

Has your small animal ever bitten a person or another animal?

If the bite broke skin, was blood drawn?

If the bite drew blood, was medical treatment necessary? If yes, please explain below.

What was the reason your small animal bit a person or animal?

Was a bite report filed with the county or city where you live?

Please provide any and all information possible that may help us understand your small animal's behavior and the circumstances leading up to and/or surrounding the bite incident.

First & Last Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Suite/Unit/Apt #

CityState / Province

Postal / Zip Code

If you need to surrender more than one small animal, you must complete separate questionnaires for each as they are individuals and have different personalities and history. Right click here to open this link in a new tab so once you are done completing this form, you can move right on over to the next one.

Small Animal's Name

Hank, Fluffy, Charles, Lola, etc.

Small Animal's Age

3 days, 3 months, 3 years, etc.

Small Animal's Sex/Gender

Is your small animal spayed/neutered?

How long have you owned your small animal?

3 days, 3 months, 3 years, etc.

What is the reason(s) you need to surrender your small animal to the Baltimore Humane Society?

Please provide as much detail as possible.

Including yourself, how many people of the following ages live in your household? Please check all that apply below.

Rows	Female	Male
0-3 years old
4-9 years old
10-17 years old
18-29 years old
30-59 years old
60 years +

What other animals has your small animal lived with? (check all that apply)

If lived with other small animals, please list what type and if they were caged or loose in your home.

Describe your small animal's behavior towards other animals (check all that apply)

Would you recommend placing this small animal into a home with other animals?

Other

What size was your small animal's cage or hutch?

Where was their cage/hutch located within your home?

Other

If housed indoors, which room was their cage/hutch located?

How many hours a day was your small animal being interacted with?

How often was your small animal provided time outside of its cage/hutch?

Does your small animal like to be pet?

Does your small animal like to be picked up/held?

Does your small animal thump its feet or growl when someone or other animals come near its cage/hutch?

Is your small animal litter box trained?

Describe your small animal's feeding schedule (brand of food, how much/how often, etc.)

Timothy Hay, Kay-tee, Pellets, Twice daily, etc.

Did you feed your small animal fruits/veggies?

If fed fruits/veggies, how often and what kind?

If your small animal likes anything in particular (fruits, veggies, treats, etc.) please list it here.

Is your small animal fed hay? If yes, what type and how often?

If children lived in the home, please describe their behavior when interacted with your small animal.

Would you recommend this small animal live with children in their next home? Please explain below.

Are there any quirks or habits you were not fond of about your small animal? (Many quirks or habits are common behaviors natural to a particular species and/or have simple solutions, which the shelter staff can share with future adopters.)

When was the last time your small animal visited a veterinarian?

Name of Veterinary Hospital/Clinic

Timonium Animal Hospital, Chadwell, etc.

Veterinary Hospital/Clinic Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

If your small animal has any medical concerns or is currently perscribed medication, please describe below.

Small Animal SURRENDER Questionnaire (Personality Profile)

Bite History

Owner Information

General Pet Information

Home Life

Diet / Feeding Schedule

Experience with Children

Health/Medical History