BHS Cat SURRENDER Questionnaire (Personality Profile)

Cat Surrender Questionnaire (Personality Profile)

The Baltimore Humane Society CANNOT ACCEPT STRAY/FOUND ANIMALS. If the cat you need to surrender is a stray and/or you are not the owner, you must contact either Baltimore County Animal Services or Baltimore City Animal Control.
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.
Adopted from BHSFriend/PrivateBreederFound/StrayPet StoreOther Shelter/RescueFamily MemberOther
Name of shelter/rescue where you adopted this cat?*
BARCS, MDSPCA, Baltimore County Animal Services, etc.
Yes, but they do not want the cat backYes, but I haven't heard back from themNo, I have not contacted themNo, I don't want to contact them
Owner Information
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
Pet Information
Cat's Name*
Steve, Charlie, Luna, etc.
Cat's Age*
3 days, 3 weeks, 3 months, etc.
MaleFemaleI don't know
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.
YesNoI don't know
MovingHousehold member is allergicLandlord restrictionsNo longer have timeSeparation/DivorceSheds too muchDestructive scratchingFinancial reasonsHas too much energyDoesn't listenOwner passed awayEscapes too oftenLitter box issuesPet's medical diagnosis or illnessAggressive behaviorsDoesn't get along with other pets in homeJust don't want it anymoreParents won't allow pet in homeOther
Please provide as much detail as possible as to why you need to surrender your cat to BHS.*
Bite History

Since ownership
YesNo
YesNo
YesNo
YesNo
When did the bite incident occur?*
Ex: 7 days ago, 5 weeks ago, 2 years ago, etc.
Medical treatment was necessary for person who was bitCat bit while at a vet appointmentCat bit while at a grooming appointmentCat bit while being picked upCat bit while a cat fight was being broken upCat bit while food, treats, catnip, and/or toys were involvedCat was in severe pain due to an illness or injuryOther
YesNoI don't know
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. *
Household Information

Has never lived with any other animalsCatsDogsSmall animals (guinea pigs, rabbits, birds, reptiles, etc.)
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.

QuietActiveBusyLoudCrowdedSpacious
Free range of the houseIndoors at nightIndoors in cold weatherScreened-in porchGarage/basementOutdoors in warm weatherBarn/shedIndoors with outdoor accessOther
OutdoorsBedroomBathroomKitchenLiving RoomGarage/basementLaying on a windowsillBarn/shedWherever people areScreened-in porchOther
LikesCries/meowsBecomes destructiveInappropriately urinates/defecates outside litter boxKnocks things overOther
I don't know, never triedCries/meowsBecomes destructiveUrinates/defecates in carrierPants/droolsDoesn't mindLoves itOther
Personality and Behavior
High energy/kitten-likeMellow/easy-goingLap cat/snugglerAffectionateResponsive/intelligentIndependentTalkativeQuietDestructive
If this cat is afraid of anything, please give us as much detail as possible.*
Ex: new people, loud noises, children, dogs, etc.
I don't know, never triedLoves itTolerates itDoesn't like at allTries to biteSwatsHides or runs away
I don't know, never triedLoves itTolerates itDoesn't like it at allTries to biteSwatsHides or runs away
YesNoI don't know, I've never tried
What type of toys does your cat like?*
Ex: Feathered wand toys, balls, anything interactive, does not seem interested in toys, etc.
I don't know, never been around children that I know ofIndifferent/ignores/co-existsAffectionate/playfulJumps up onPlays roughTolerates, but has limit(s)Nervous/fearful/anxiousGrowls/swats/hissesHides/cowers/runs awayOther
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.
I don't know, never been around childrenGently petsChasesLays/sits onHugs/snuggles/sleeps withTugs ears/tailGrabs fur/pawsDresses upHits/smacksOther
Cat has never been around childrenAlwaysSometimesNever
YesNo
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

2

3

4

5

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.
Litter Box Habits
YesNo
YesNo
Covered/HoodedUncovered/OpenPlasticCardboardThis cat does not have access to a litter boxSelf-Cleaning/AutomaticStainless SteelOther
12 or moreMany cats sharedMultiple boxes for multiple cats
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?

DailyEvery few daysWeeklyRarelyNever
CrystalClayPinePaperScentedUnscentedClumpingNon-clumpingPelletWalnutCornOther
DailyEvery few daysWeeklyRarelyNever
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.
Confined cat to a specific roomPut cat outsideConfined to cat carrierConsulted my vetNothing, just let it goHit catYelled at catRubbed cat's nose in itUsed a deterrent sprayUsed cat attractUsed a calming spray/diffuserOther
Medical History/Veterinary Care
YesNoI don't know
Fine/relaxedNervous, but toleratesGrowls/hissesTerribly, has to be muzzledTries to biteSwats/lunges
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
Has never been to the vetAnnual check-up/vaccinesIllness/injurySpay/neuter surgeryI don't knowOther
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!

Cancelof
I understand
I understand
Should be Empty:

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 +

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

Cat Surrender Questionnaire (Personality Profile)

Owner Information

Pet Information

Bite History

Household Information

Personality and Behavior

Litter Box Habits

Medical History/Veterinary Care