Owner Surrender Request

Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Secondary Number
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The following questions will ask about this pet's behavioral and medical history. After you submit this form, our client services team will call or email you to further discuss the information provided and to schedule a return appointment. Please expect to answer calls from 650-367-1405.

Surrender Request

Documents
Reason for surrender:*
Microchip Number*
Upload a current photo of your pet.*

Browse Files

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Upload medical records.*

Browse Files

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Upload a picture of your photo ID.*

Browse Files

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Upload proof of ownership. This can be vet records, adoption or purchase paperwork, or microchip records.*

Browse Files

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Upload proof of residency in Palo Alto, Los Altos, or Los Altos Hills. This can be a current ID, tax forms, or car registration. You must bring physical copies with you at the time of surrender.*

Browse Files

Cancelof
Are you the owner or regular caregiver of this pet?*

YesNo
What is your relationship to the owner?*
Where did this pet originally come from? (found, given, shelter/rescue - specify which one.)*
How long have you been caring for this pet?*
How soon do you need to rehome this pet?*
Please note that you will be asked to present a copy of the proof of ownership, proof of residency, and your physical photo ID at the time of surrender. The same name must be on all three documents.

Surrender Request

Health
Provide the name of your vet clinic (or where your pet received vaccinations):*
When was your pet last vaccinated?*
Does your pet have any signficant or chronic health issues, surgeries, or current medications?*

YesNo
Please describe your pet's health issues, surgeries or medications:*
What brand of food is your pet currently eating?*
Has your rabbit received a vaccine for Rabbit hemorrhagic disease (RHDV2)?*

Yes, one vaccineYes, two vaccinesNo
Has your rabbit exhibited any of the symptoms below?*

YesNoNot sure
- Bleeding from nose, mouth, or anus
- Bruising, swelling
- Lethargy, weakness, collapse, inability to stand, paralysis
- Jaundice (yellow discoloration of skin, eyes, gums)
- Decreased awareness/responsiveness, vocalizations
- Difficulty breathing, nasal discharge, congestion, conjunctivitis, bluish mucous membranes
- Incoordination, abnormal body position or posture, spasms, seizures
- Fever
- Lack of appetite, weight loss, bloating, diarrhea

Surrender Request

Other Pets
Does your pet liked to be picked up?
Does your pet like to be petted?
Check all that describe your pet's personality.

FriendlyShyIndependentFearfulPlayfulAffectionateAloofAggressiveOverly Reactive
What is your pet's favorite toy or activity?
What is your pet's worst quality?
What is your pet's best quality?

Please verify that you are human*
Include any additional information about your pet that would be helpful to Pets in Need or a new owner. This will help us make the best possible match for a new home.
After you submit this form, our client services team will call or email you to further discuss the information provided and to schedule a return appointment. Please expect to answer calls from 650-367-1405.
Should be Empty:

	No Reaction	Curious	Barking	Avoidant	Other
The postman or delivery person comes to your door.
Someone knocks on your door.
A visitor comes into the house.
A visitor tries to pet them inside your home.
A stranger approaches you while they are on a leash on a walk.
A stranger attempts to pet them while they are on a leash on a walk.
Someone goes near the food bowl when they are eating.
Someone tries to take away toys, chews, or anything else they value.
Someone hugs them.

Surrender Request