BHS Cat SURRENDER Questionnaire (Personality Profile)

If you adopted your animal from The Baltimore Humane Society, please call the Adoption Center at 410-833-8848, Ext/Opt 2 to schedule your cat return appointment. You do not need to complete this form. Thank you.

Where did you originally obtain this cat?

Name of shelter/rescue where you adopted this cat?

BARCS, MDSPCA, Baltimore County Animal Services, etc.

Have you contacted the shelter/rescue where you originally adopted your cat?

First & Last Name

First NameLast Name

Email Address

example@example.com

Phone Number

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

Alternate/Additional Owner Phone Number

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

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cat's Name

Steve, Charlie, Luna, etc.

Cat's Age

3 days, 3 weeks, 3 months, etc.

Cat's Sex

How long have you owned your cat?

Ex: 3 days, 3 weeks, 3 months, 3 years, etc.

Cat's Coloring/Markings

Black, White, Brown Tabby, Calico, Tortie, etc.

Is this cat spayed/neutered/altered/fixed?

Why do you need to surrender your cat to BHS? (please select all that apply)

Please provide as much detail as possible as to why you need to surrender your cat to BHS.

Has this cat ever bitten a person while in your care?

Has this cat ever bitten another animal while in your care?

Has this cat ever bitten to where it broke the person's skin while in your care?

Has this cat ever bitten to where it drew blood from the person while in your care?

When did the bite incident occur?

Ex: 7 days ago, 5 weeks ago, 2 years ago, etc.

Please select all that apply to this cat's bite incident (select all that apply)

Other

Was a bite report filed with the state's health department/your county's animal control?

Please give as much detail as possible as to what occurred before, during and after the bite incident, who was involved, and anything you'd like to share regarding the incident.

Including yourself, please check all ages and genders of the humans this cat has lived with 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 type(s) of animals has this cat lived while in your care? (check all that apply)

If this cat has lived with other animals, please provide the TYPE, AGE, SEX and HOW ANIMALS INTERACTED;

Ex: My cat has lived with 2, senior aged female cats and a young small breed dog, etc.

What is your cat's current feeding schedule? (type N/A or leave blank if not offering in daily diet)

Rows	Brand (Ex: Purina, Friskies, etc.)	Amount (1/4 cup, 1 can, etc.)	Frequency
Dry
Wet
Treats
People Food

How would you describe your household? (check all that apply)

What areas of your home does your cat have access to? (check all that apply)

Where does your cat spend most of their time when you are at home? (check all that apply)

How does your cat react to being left home alone? (check all that apply)

How does your cat react to being taken in the car? (check all that apply)

Describe your cat's temperament and activity level (check all that apply).

If this cat is afraid of anything, please give us as much detail as possible.

Ex: new people, loud noises, children, dogs, etc.

How does this cat react to being picked up/held?

How does this cat react to being groomed/brushed?

Does your cat like to use scratching posts/any type of scratcher?

What type of toys does your cat like?

Ex: Feathered wand toys, balls, anything interactive, does not seem interested in toys, etc.

How does this cat typically behave around children? (check all that apply)

If this cat has been around children, please describe in detail how this cat behaves around children.

Ex: is terrified, runs from OR loves, purrs, cuddles with, plays with toys, etc.

How do children typically behave around this cat?

Were all children interactions with this cat supervised by an adult?

If this cat did not live in a home with children, did children visit regularly?

If children visit your home regularly, how old are they?

all under the age of 5 years old, newborn, etc.

On a scale from 1 to 5, how likely are you to recommend this cat live in a home with children under the age of 12 years old?

1 is NOT AT ALL, 5 is EXTREMELY

Please elaborate on your reasoning either to recommend or not recommend this cat being adopted into a home where either children live or visit regularly.

Ex: I would, but only children older than 12 years old as she gets overstimulated easily and requires space.

Does this cat have access to a litter box in your home?

Has this cat had any issues using its litter box?

What type of litter box does this cat currently have access to? (check all that apply)

If there are other cats in your home, how many litter boxes do the cats have access to?

Where is this cat's litter box located within your home?

Ex: One on every floor, living room, bathroom, laundry room, basement, etc.

Litter Box Cleaning Schedule

Rows	Daily	Biweekly	Weekly	Monthly	Never
How often do you scoop the litter box?
How often do you change the litter?
How often do you fully clean the box?

How often is the litter box scooped?

What type of litter does this cat prefer? (check all that apply)

How often do you fully clean the litter box? (change litter and spray box clean)

If litter box accidents have been an issue, please provide as much detail as possible.

Ex: When did it start? How often? What type? (urination/defecation), etc.

If you've experienced inappropriate urination/defecation, what are some things you've tried to rectify the situation? (check all that apply)

Has this cat been to a veterinarian while in your care?

How does this cat behave at the vet? (check all that apply)

Name of Veterinary Clinic/Hospital

Phone Number of Veterinary Clinic/Hospital

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

Name of Owner/Caretaker on Vet Account

First NameLast Name

Most recently, what was the reason this cat was taken to the vet?

If you've taken your cat to the vet within the past year due to an illness/injury, please explain in detail what happened.

Ex: My cat was coughing a lot so I took her to the vet and she had a URI, etc.

Does this cat have an current or past medical concerns that you are aware of? If yes, please describe in as much detail as possible below.

If there is anything else you feel would be helpful for future adopters to know about this cat, please provide detail below.

If you'd like to add some of your favorite photos of your pet, we'd greatly appreciate it!

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

I understand that The Baltimore Humane Society is a non-profit organization and that I am responsible a surrender fee of $85 for a cat or litter of kittens who are not neutered/spayed or $50 for a cat who is already neutered/spayed.

Cat Surrender Questionnaire (Personality Profile)

Owner Information

Pet Information

Bite History

Household Information

Personality and Behavior

Litter Box Habits

Medical History/Veterinary Care