FieldHaven Feline Center – Peace of Mind Cat Guardian Program

FieldHaven Peace of Mind Cat Guardian Program – Cat Information Form

Please fill this form out as completely as possible. No one knows and loves your cat the way you do. In order tofind the most appropriate home for your cat, please provide as much detail as possible about history, pastveterinary care, likes, and quirks of your feline friend (and be honest!). Behavioral and medical issues do notnecessarily create problems, but failing to disclose them certainly can. Please provide one for each cat enteringthe program. Feel free to attach any additional information and a photo to this document.
Personal Details
Email Address *
example@example.com
Full Name *

First Name Last Name

Home Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Cat General Information
Cat's Name *
Cat's Birthdate *

Month Day Year
Date
Cat's Sex *
Is your cat spayed or neutered? *

Yes No
Is your cat microchipped? *

Yes No Not sure
Who is the microchip registered to?

Self Someone else
Microchip Company
Microchip Number
Has your cat ever bitten anyone? *

Yes No
If so, when?

Month Day Year
Date
If yes, please check all that apply

Love bite Play bite Bite clothing Only minor bite (did not break skin or leave bruising) Bite (broke skin) Major bite (broken skin/blood drawn/bruising)
Where did you obtain your cat? *

FieldHaven Breeder Stray Another shelter Pet store Friend/family Craigslist Born in my home
How long has the cat lived with you? *
Is your cat declawed? *

Yes No
If yes

Front paws only All four paws
If yes, when

As a kitten As an adult Acquired declawed
Personality & Behavior
How would you describe your cat most of the time? Check all that apply: *

Very active Friendly to family A clown Couch potato Shy to family Shy to visitors Playful Talkative Affectionate Independent Aloof Quiet Lap cat Withdrawn Playful Fearless Solitary More like a dog
Where, if any, does your cat like being petted? *
Play Style
How does your cat like to play? Check all that apply: *

Plays gently, does not use teeth or claws Likes to play rough, may nip or scratch Likes to chase and pounce with a variety of toys Likes things that crackle, like paper bags Likes to play hide and seek Will fetch items like bottle caps or toys Likes to learn new tricks for treats Likes to play with other cats Likes to play with dogs Not much interest in play Chases bugs or moths Likes to play in or around water
Lifestyle & Home Life
What areas of your home did your cat have access to? Check all that apply: *

Indoors only Outdoors only Indoors at night Garage or basement Indoors with access to outside Screened porch Indoors in cold weather In barn or shed Outdoors in warm weather
Has your cat regularly been around children? *

Yes No Not sure
If yes, indicate what ages:

0 – 2 years 3 – 5 years 6 – 10 years 11 – 18 years
If your cat lived with children, how did they interact? Check all that apply:

Cat actively avoided the child Child could pet the cat Mutual adoration Ignored each other Cat and child played together Cat hissed or growled at child
Have the experiences with your cat and children always been positive?

Yes No
If no, please explain:
Is your cat more comfortable with: *

Women Men Kids Seniors Loves all people
Health & Dietary Habits
Does your cat see a veterinarian on a regular basis (at least once a year)? *

Yes No
Which vet office/clinic is your cat seen at?
Are there any illnesses or conditions a new owner should know about? *

Yes No
If yes, please explain:
What does your cat eat? *

Dry only Wet only Combination of dry and canned People food
Does your cat have a preferred brand and flavor? *
What type of treats does your cat enjoy? *
How often do you feed your cat? *

Food always available Fed once a day Fed twice a day
Does your cat need a special diet? *

Yes No
If yes, please describe
Would you consider your cat to be a picky eater? *

Yes No
Is your cat on any type of flea treatment? *

Yes No
If yes, what kind?

Advantage Frontline Revolution
Litter Box Use
Did your cat have access to a litter box in the house? *

Yes No
If no, did your cat use the bathroom only outdoors?

Yes No
If sometimes, how often does your cat make mistakes? *
Please describe the accidents:

Urinates outside the box Defecates outside the box Urinates on clothing/furniture Sprays on walls/furniture All of the above
How often was the litter box scooped? *

Every day Every few days Weekly Rarely
What type(s) of litter was used? *

Unscented Scented Clumping Non-clumping Crystal Clay
If other cats are in your home, how many shared a litter box?

One Two or more
If litter box accidents were an issue, when did they begin?

Past month Past year Ongoing
Can you pinpoint an event or events that might have influenced or triggered inappropriate litter box use?
Please describe what measures you have taken to correct this problem
Has your cat been to the veterinarian to rule out infection or underlying health issues?

Yes No
If yes, what was the outcome?
What else would you like us to know about your cat?
Other Animals
Has your cat lived with other animals? *

Yes No
How many dogs? *
What were the sexes of the dogs?

Male Female
How did they behave with the dogs?

Ignored Acted bossy Played with Acted shy
How many cats? *
What were the sexes of the cats?

Male Female
How did they behave with the cats?

Ignored Acted bossy Played with Acted shy
How many other animals? *
What were the sexes of the other animals?

Male Female
How did they behave with the other animals?

Ignored Acted bossy Played with Acted shy
Image(s) of cat(s)

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FieldHaven Peace of Mind Cat Guardian Program – Cat Information Form

Personal Details

Cat General Information

Personality & Behavior

Play Style

Lifestyle & Home Life

Health & Dietary Habits

Litter Box Use

Other Animals

Office Use Only