Small Animal SURRENDER Questionnaire

Small Animal SURRENDER Questionnaire (Personality Profile)

We cannot accept found/stray animals. If the pet you need to surrender is a stray and/or you are not the owner, you must contact Baltimore County Animal Services at 410-887-7297.
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.*

I understand
What type of small animal do you need to surrender?*

Guinea PigRabbitHamsterRatMouseGerbil
Where did you originally obtain your small animal?*

Adopted from BHSFriend/PrivateBreederFound/StrayPet StoreOther Shelter/Rescue
Bite History
Has your small animal ever bitten a person or another animal?*

YesNo
If the bite broke skin, was blood drawn?*

YesNo
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?*

Trying to break up a small animal fightSmall animal was in painSmall was eating or playing with a toySmall animal was at the vetSmall animal was being heldSmall animal was getting nails trimmedSmall animal was being bathedSmall animal was being placed in a carrier
Was a bite report filed with the county or city where you live?*

YesNoI don't know
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. *
Owner Information
First & Last Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Suite/Unit/Apt #

CityState / Province

Postal / Zip Code
General Pet Information
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.
Home Life

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

Has not lived with other animalsDogsCatsRabbitGuinea PigOther
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)*

Never been aroundFriendly/playfulAggressiveScared/timidIgnores/indifferentGentle/submissiveRoughhousesOther
Would you recommend placing this small animal into a home with other animals?*

YesNoOther
What size was your small animal's cage or hutch?*
Where was their cage/hutch located within your home?*

IndoorsOutdoorsOther
If housed indoors, which room was their cage/hutch located?
How many hours a day was your small animal being interacted with?*

Never interacted withLess than 1 hour2-4 hours5 hours or more
How often was your small animal provided time outside of its cage/hutch?*

Never outside of cageLess than 1 hour2-4 hours5 hours or moreAlways outside of cage
Does your small animal like to be pet?*

YesYes, but only for short periods of timeNo
Does your small animal like to be picked up/held?*

YesYes, but for short periods of timeNo
Does your small animal thump its feet or growl when someone or other animals come near its cage/hutch?*

YesNo
Is your small animal litter box trained?*

YesNo
Diet / Feeding Schedule
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?*

YesNo
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?
Experience with Children
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.)*
Health/Medical History
When was the last time your small animal visited a veterinarian?*

Never been to a vetLess than 6 months agoLess than a year agoOver a year agoI don't know
Name of Veterinary Hospital/Clinic*
Timonium Animal Hospital, Chadwell, etc.
Veterinary Hospital/Clinic Phone Number*
Please enter a valid phone number.
If your small animal has any medical concerns or is currently perscribed medication, please describe below.
Should be Empty:

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

Small Animal SURRENDER Questionnaire (Personality Profile)

Bite History

Owner Information

General Pet Information

Home Life

Diet / Feeding Schedule

Experience with Children

Health/Medical History