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 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.
Where did you originally obtain this cat?*

Adopted from BHSFriend/PrivateBreederFound/StrayPet StoreOther Shelter/RescueFostered for BHSOther
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?

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*
example@example.com
Phone Number*
Please enter a valid phone number.
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.
Cat's Sex*

MaleFemaleI don't know
Cat's Coloring*
Black, White, Brown Tabby, etc.
Is your cat spayed/neutered?*

YesNoI don't know
How long have you owned your cat?*
Ex: 3 days, 3 weeks, 3 months, 3 years, etc.
Why do you need to surrender your cat to BHS? (please check all that apply)*

MovingHousehold member is allergicLandlord restrictionsNo longer have timeSeparation/DivorceSheds too muchDestructive scratchingFinancial reasonsHas too much energyDoesn't listenDeath of ownerEscapes the home too oftenLitter box issuesPet's medical problemsBite historyDoesn't get along with other pets in homeJust don't want it anymoreOther
Please provide a little more detail as to why you need to surrender your cat to the Baltimore Humane Society.*
Bite History
Has this cat ever bitten a person?*

YesNoI don't know
Has this cat ever bitten another animal?*

YesNoI don't know
Has this cat ever bitten to where it broke the person's skin?*

YesNoI don't know
Has this cat ever bitten to where it drew blood from the person?*

YesNoI don't know
If this cat has ever bitten a person, when did the most recent bite incident occur?
Ex: 7 days ago, 5 weeks ago, 2 years ago, etc.
If this cat has bitten a person and it drew blood, please select all that apply to your cat's bite incident.

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

YesNoI don't know
Household Information

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

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

Free range of the houseIndoors at nightIndoors in cold weatherScreened-in porchGarage/basementOutdoors in warm weatherBarn/shedIndoors with outdoor accessOther
Where does this cat spend most of their time when you are at home? (check all that apply)*

OutdoorsBedroomBathroomKitchenLiving RoomGarage/basementLaying on a windowsillBarn/shedWherever people areScreened-in porchOther
How does this cat react to being left home alone? (check all that apply)*

LikesCries/meowsBecomes destructiveInappropriately urinates/defecates outside litter boxKnocks things overOther
How does this cat react to being taken in the car? (check all that apply)*

I don't know, never triedCries/meowsBecomes destructiveUrinates/defecates in carrierPants/droolsDoesn't mindLoves itOther
Personality and Behavior
Describe this cat's temperament and activity level (check all that apply).*

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.
Does this cat like to be held, picked up and/or carried?*

YesNoI don't know, I've never tried
Does this cat like to be bathed, groomed and/or brushed?*

YesNoI don't know, I've never tried
Does this cat like to use scratching posts?*

YesNoI don't know, I've never tried
Does this cat enjoy playing with toys?*

YesNoI don't know, I've never tried
How does this cat typically behave around children? (check all that apply)*

I don't know, never been around children that I know ofIndifferent/ignores/co-existsAffectionate/playfulJumps onPlays roughTolerates, but has limit(s)Nervous/fearful/anxiousGrowls/swatsHides/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.
How do children typically behave around this cat?*

I don't know, never been around childrenGently petsChasesLays/sits onHugs/snuggles/sleeps withTugs ears/tailGrabs fur/pawsDresses upHits/smacksOther
Were all children interactions with this cat supervised by an adult?*

Cat has never been around childrenAlwaysSometimesNever
If this cat did not live in a home with children, did children visit regularly?*

YesNo
If children visit your home regularly, how old are they?
all under the age of 5 years old, newborn, etc.
Based on your experience with this cat, would you RECOMMEND this cat live in a home with children or where they visit regularly? Please explain your reasoning and if you recommend an age range, if any, etc.*
Ex: I would, but only children older than 12 years old as she gets overstimulated easily and requires space.
Litter Box Habits
Does this cat have access to a litter box in your home?*

YesNoI don't know
Does this cat have any current or past litter box accident issues?*

YesNoI don't know
What type of litter box does this cat currently have access to? (check all that apply)*

CoveredUncoveredPlasticCardboardThis cat does not have access to a litter boxAutomaticOther
If there are other cats in your home, how many litter boxes do the cats have access to?

12 or moreMany cats sharedMultiple boxes for multiple cats
Where was this cat's litter box located within your home?*
Ex: One on every floor, living room, bathroom, laundry room, basement, etc.
What type of litter does this cat like? (check all that apply)*

CrystalsClayPineNewspaperScentedUnscentedClumpingNon-clumpingPelletOther
How often do you scoop the litter box?*

DailyEvery few daysWeeklyRarelyNever
How often do you fully clean the litter box? (change litter and spray box clean)*

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

Confined cat to specific roomPut cat outsideConfined to cat carrierConsulted vetNothingHit catYelled at catRubbed cat's nose in itOther
Medical History/Veterinary Care
Has this cat ever been to see a veterinarian?*

YesNoI don't know
How does this cat behave at the vet? (check all that apply)*

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.
Most recently, what was the reason you took your cat to the vet?*

Has never been to the vetAnnual check-up/vaccinesIllness/injurySpay/neuter surgeryOther
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 you'd like to add some of your favorite photos of your pet, we'd greatly appreciate it!

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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
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.*

I understand
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 +

	Lived with?	Please describe how they interacted in your household (ex: friendly, loved to play/snuggle, co-existed, kept separate/never interacted with, etc.)
Dogs
Cats
Small Animals

	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