Small Animal/Bird Surrender Form
Rabbits, Guinea Pigs, etc.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Pet's Name
*
Species:
*
Age of Pet:
*
Is your pet:
*
Male
Female
Unknown
Where did you aquire your pet?
*
Pet Store
Friend/Relative
Other Shelter/ Rescue
Breeder
Found/Stray
Other
Why are you surrendering your pet?
*
What types of food do you feed your pet?
*
Brand of food:
Treats:
Supplements:
Where does your pet spend most of it's time?
*
Outside
Free Roam (Inside home)
Single Enclosure (Inside home)
Other
What type & size is your pet's cage?
*
Is your pet litter box trained?
*
yes
no
Has your pet bitten or scratched anyone? If yes please explain
*
What other pets live in your house?
*
No other animals
cat(s)
dog(s)
bird(s)
Other small animal(s)
Pet's reaction to being picked up?
*
Never Tried
Enjoys
Allows
Afraid
Reactionary (bites/scratches)
Has your pet had any health problems in the past?
*
Has your pet been seen by a veterinarian?
*
Yes
No
If yes, please provide the Veterinarian's name and phone #
Upload an Image of your pet here:
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Drag and drop files here
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Is there anything else that you would like us to know about your pet?
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