Pet History Surrender Form

For Animals Surrendered to the Shelter

You must be a resident of Oak Ridge, TN, to surrender a pet. Please help us attempt to find your pet a good, permanent home by completing this questionnaire. Thank you!
Your name*
Date*

MonthDayYear
Date
Phone number*
Email Address*
example@example.com
Address*

Your address

Street Address Line 2

CityState / Province

Postal / Zip Code
State*
Your ID #*
ID State Issued:*
DOB*
Pet's Name*
Age*
Breed*
Weight*
Approximate weight
Sex*
Male/Female
Is your pet spayed/neutered? *
Yes/no
Is your pet up to date on vaccines?*
Yes/no/unsure
****If yes, then please email a copy of your pet's vaccines records when you submit this form.
Why do you need to surrender your pet?*
Who has been your veterinarian for this pet?*
Vet phone*
How long have you had this pet?*
Where did you get this pet?*
Did your pet live with children?*
If so, what ages?*
Has your pet negatively reacted to any of the following?*
If you marked any of the above, then please explain: *
N/A if you marked none of the above
Is your pet on a special diet? If so, please explain. *
Does your pet have an illness or require any special medications? If so, please explain. *
Is your pet house broken/litter box trained? *
Yes/No
Does your pet enjoy grooming/bathing?*
Yes/No
Please make any other comments on your pet's behavior or temperament that would help us find a suitable home:*
Should be Empty: