Feline Rescue Intake Triage

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workflow ID
Case Type
Case Status
Intake Triage Form

This form is to be completed by the owner or rescuer of the cat, the person who has the legal authority to relinquish it to Feline Rescue. Please note if the owner is recently deceased or hospitalized and you are acting on their behalf.
Tell Us About Yourself
Name*

First NameLast Name
Partner/Spouse/Roommate Name

First NameLast Name
Primary Email*
example@example.com
Secondary Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Zip Code*
Primary Phone*
Please enter a valid phone number.
Secondary Phone
Please enter a valid phone number.
Additional Phone
Please enter a valid phone number.
Age
Gender
Race
Hispanic/Latino?
How many cats are you relinquishing?*
Pet 1 Information
Pet's Name*
Animal Type
Please upload a photo of the pet. *

Cancelof
Pet's Gender*

MaleFemaleUnknown
Pet's Age*

Kitten (Under 4 months)Young Adult (Between 4 months and 3 years)Adult (Between 3 years and 10 years)Senior (10+ years)
Spayed or Neutered?*

Spayed or NeuteredIntactUnknown
Cat Origin:*

Returning a Feline Rescue catI am surrendering a cat adopted from another organization.I am surrendering a cat acquired from another person.I am bringing you a cat that I found.
When did you acquire this cat?*
Has the pet bitten anyone and broken skin in the last 10 days?*

YesNoNot Sure
Please list the date the cat last broke someone’s skin:*

MonthDayYear
Date
Please provide details regarding the circumstances of the bite incident.*
Has this cat ever seen a veterinarian, other than one at Feline Rescue?*

Yes, this cat has been to the vetNo, this cat has not been to the vet
If yes, at what veterinary clinic/hospital has this cat been seen? Please be sure to include the specific location, if there are multiple locations.
In what year was this cat last seen at this clinic?
Please select all that applies to your pet’s physical condition:*

CoughingSneezingDiarrheaNot EatingVomitingEye DischargeNose DischargeSkin IssueInjuredOther Medical ConditionHealthy - No known medical conditions
If you selected any of the above, please detail the medical condition below:
Has this cat ever had a dental cleaning, with or without extractions?*

Yes, this cat has had a dental cleaning.No, this cat has not had dental cleanings.
Please help us to plan our kennel space. Most cats that weigh 15 pounds or less will be able to navigate our kennel levels and fit through our portals, which have a 7” diameter hole. Does this cat weigh more than 15 pounds?*

Over 15 pounds15 pounds or less
Pet 2 Information
Pet's Name *
Animal Type
Please upload a photo of the pet. *

Cancelof
Pet's Gender*

MaleFemaleUnknown
Pet's Age*

Kitten (Under 4 months)Young Adult (Between 4 months and 3 years)Adult (Between 3 years and 10 years)Senior (10+ years)
Spayed or Neutered?*

Spayed or NeuteredIntactUnknown
Cat Origin:*

Returning a Feline Rescue cat.I am surrendering a cat adopted from another organization.I am surrendering a cat acquired from another person.I am bringing you a cat that I found.
When did you acquire this cat?*
Has the pet bitten anyone and broken skin in the last 10 days?*

YesNoNot Sure
Please list the date the cat last broke someone’s skin:*

MonthDayYear
Date
Please provide details regarding the circumstances of the bite incident.*
Has this cat ever seen a veterinarian, other than one at Feline Rescue?*

YesNo
If yes, at what veterinary clinic/hospital has this cat been seen? Please be sure to include the specific location, if there are multiple locations.
In what year was this cat last seen at this clinic?
Please select all that applies to your pet’s physical condition:*

CoughingSneezingDiarrheaNot EatingVomitingEye DischargeNose DischargeSkin IssueInjuredOther Medical ConditionHealthy - No known medical conditions
If you selected any of the above, please detail the medical condition below:
Has this cat ever had a dental cleaning, with or without extractions?*

Yes, this cat has had dental cleaningsNo, this cat has not had dental cleanings
Please help us to plan our kennel space. Most cats that weigh 15 pounds or less will be able to navigate our kennel levels and fit through our portals, which have a 7” diameter hole. Does this cat weigh more than 15 pounds?*

Over 15 pounds15 pounds or less
Pet 3 Information
Pet's Name *
Animal Type
Please upload a photo of the pet. *

Cancelof
Pet's Gender*

MaleFemaleUnknown
Pet's Age*

Kitten (Under 4 months)Young Adult (Between 4 months and 3 years)Adult (Between 3 years and 10 years)Senior (10+ years)
Spayed or Neutered?*

Spayed or NeuteredIntactUnknown
Cat Origin:*

Returning a Feline Rescue cat.I am surrendering a cat adopted from another organization.I am surrendering a cat acquired from another person.I am bringing you a cat that I found.
When did you acquire this cat?
Has the pet bitten anyone and broken skin in the last 10 days?*

YesNoNot Sure
Please list the date the cat last broke someone’s skin:*

MonthDayYear
Date
Please provide details regarding the circumstances of the bite incident.*
Has this cat ever seen a veterinarian, other than one at Feline Rescue?*

YesNo
If yes, at what veterinary clinic/hospital has this cat been seen? Please be sure to include the specific location, if there are multiple locations.
In what year was this cat last seen at this clinic?
Please select all that applies to your pet’s physical condition:*

CoughingSneezingDiarrheaNot EatingVomitingEye DischargeNose DischargeSkin IssueInjuredOther Medical ConditionHealthy - No known medical conditions
If you selected any of the above, please detail the medical condition below:
Has this cat ever had a dental cleaning, with or without extractions?*

Yes, this cat has had dental cleanings.No, this cat has not had dental cleanings.
Please help us to plan our kennel space. Most cats that weigh 15 pounds or less will be able to navigate our kennel levels and fit through our portals, which have a 7” diameter hole. Does this cat weigh more than 15 pounds?*

Over 15 pounds15 pounds or less
Pet 4 Information
Pet's Name *
Animal Type
Please upload a photo of the pet. *

Cancelof
Pet's Gender*

MaleFemaleUnknown
Pet's Age*

Kitten (Under 4 months)Young Adult (Between 4 months and 3 years)Adult (Between 3 years and 10 years)Senior (10+ years)
Spayed or Neutered?*

Spayed or NeuteredIntactUnknown
Cat Origin:*

Returning a Feline Rescue cat.I am surrendering a cat adopted from another organization.I am surrendering a cat acquired from another person.I am bringing you a cat that I found.
When did you acquire this cat?*
Has the pet bitten anyone and broken skin in the last 10 days?*

YesNoNot Sure
Please list the date the cat last broke someone's skin:*

MonthDayYear
Date
Please provide details regarding the circumstances of the bite incident.*
How does this cat interact with children?
Has this cat ever seen a veterinarian, other than one at Feline Rescue?*

YesNo
If yes, at what veterinary clinic/hospital has this cat been seen? Please be sure to include the specific location, if there are multiple locations.
In what year was this cat last seen at this clinic?
Please select all that applies to your pet’s physical condition:*

CoughingSneezingDiarrheaNot EatingVomitingEye DischargeNose DischargeSkin IssueInjuredOther Medical ConditionHealthy - No known medical conditions
If you selected any of the above, please detail the medical condition below:
Has this cat ever had a dental cleaning, with or without extractions?*

Yes, this cat has had a dental cleaningNo, this cat has not had a dental cleaning
Please help us to plan our kennel space. Most cats that weigh 15 pounds or less will be able to navigate our kennel levels and fit through our portals, which have a 7” diameter hole. Does this cat weigh more than 15 pounds?*

Over 15 pounds15 pounds or less
Pet 5 Information
Pet's Name *
Animal Type
Please upload a photo of the pet. *

Cancelof
Pet's Gender*

MaleFemaleUnknown
Pet's Age*

Kitten (Under 4 months)Young Adult (Between 4 months and 3 years)Adult (Between 3 years and 10 years)Senior (10+ years)
Spayed or Neutered?*

Spayed or NeuteredIntactUnknown
Cat Origin:*

Returning a Feline Rescue cat.I am surrendering a cat adopted from another organization.I am surrendering a cat acquired from another person.I am bringing you a cat that I found.
When did you acquire this cat?*
Has the pet bitten anyone and broken skin in the last 10 days?*

YesNoNot Sure
Please list the date the cat last broke someone’s skin:*

MonthDayYear
Date
Please provide details regarding the circumstances of the bite incident.*
Has this cat ever seen a veterinarian, other than one at Feline Rescue?*

YesNo
If yes, at what veterinary clinic/hospital has this cat been seen? Please be sure to include the specific location, if there are multiple locations.
In what year was this cat last seen at this clinic?
Please select all that applies to your pet’s physical condition:*

CoughingSneezingDiarrheaNot EatingVomitingEye DischargeNose DischargeSkin IssueInjuredOther Medical ConditionHealthy - No known medical conditions
If you selected any of the above, please detail the medical condition below:
Has this cat ever had a dental cleaning, with or without extractions?*

Yes, this cat has had dental cleaningsNo, this cat has not had dental cleanings
Please help us to plan our kennel space. Most cats that weigh 15 pounds or less will be able to navigate our kennel levels and fit through our portals, which have a 7” diameter hole. Does this cat weigh more than 15 pounds?*

Over 15 pounds15 pounds or less
Lifestyle Information
Do you need to surrender this cat due to a permanent life change?*

New babyRelationship endOwner healthMilitary relocation (long term)Owner incarcerated (long-term)Permanent life change not a reason
Do you need to surrender this cat due to the owner's death?*

No next of kinNext of kin unable to keepOwner death not a reason
Do you need to surrender this cat due to a short-term life change?*

Owner incarcerated (short-term)Military relocation (short-term)Owner temporarily hospitalizedDomestic violenceOwner going into substance use treatmentShort-term life change not a reason
Do you need to surrender this cat due to a housing reason?*

Temporary loss of homeRestriction on number of petsCan’t find housing that allows petsCan’t afford pet fees, pet rent, or ongoing feesHousing not a reason
Do you need to surrender this cat due to not being able to afford one of the following?*

Routine wellnessSupplies/licensePet foodTreatment for illness (non-emergency)Treatment for injury (non-emergency)Treatment for illness (emergency)Treatment for injury (emergency)Behavior supportCan’t afford not a reason
Do you need to surrender this cat due to the behavior of this cat?*

Pet needs urgent care/treatment (ex: separation anxiety, advanced fear/distress,phobias, etc.)Nuisance behavior (ex: marking, escapes, scratching furniture, strainedpet interactions - non-safety, etc.)
Cat-to-pet safety concerns (concerned about *surrendered* cat’s behavior with

other animals; do NOT select for resident/other pets’ behavior)
Cat-to-people safety concerns (concerned about cats behavior with people)Behavior not a reasonBehavior not a reason
Do you need to surrender this cat due to owner/household factors?*

Appearance, size, breed type preferencesBehavior of other pet(s) in the homeSomeone in household is experiencing allergiesNo other definitive reason for relinquishmentOwner/household factors not a reason
Do you need to surrender this cat due to not having time/being overwhelmed?*

Took ownership without intent to keepUnable to fulfill cat's mental/emotional needs (unrelated to finances)Unable to fulfill cat’s medical treatment needs (unrelated to finances)Unwanted litter(s)No time/overwhelmed not a reason
Are there any other reasons for requesting surrender for your cat that were not considered in the available options?*
What, if any, resources did you utilize on your own before deciding to surrender this cat?*
Resources

We have a few questions about support for your unique situation. The information you provide with the next few questions will help us get a better understanding of the needs in our community and how we can better support people and their cats in the future. A shelter representative will contact you regarding current service availability, as they may be limited or unavailable at this time.
If available, would any of these resources assist you in keeping your cat? (Select all that apply.)*

Cat food and/or suppliesLow-cost or free veterinary careLow-cost or free behavior support/pet trainingLow-cost or free temporary boardingMoney for pet depositsInformation on how to find housing that accepts your catInformation on cat care support (cat sitting, daycare, pet-friendly transportation,etc.)Referral to self-rehoming platformsNo assistance would be of use
If “Low-cost or free temporary boarding” was selected above, please indicate approximately how many days you would find beneficial: *
Final Information
I certify that I am the owner of the cat and thus authorized to relinquish it to Feline Rescue.*

YesNo
If you are not the owner, please explain.*
I understand that I must be able to put this cat in a carrier and bring it to Feline Rescue for us to consider it for Intake. We cannot accept cats in traps of any kind.*

YesNo
I understand that I must be able to bring this cat to the intake appointment or have someone else bring it.*

YesNo
What is the urgency of your request?*

Immediate (I need placement for this cat within 24 hours).Emergency (I need placement for this cat within 72 hours).Urgent (I need placement for this cat within 1 week).Semi-Urgent (I need placement for this cat within 2 weeks).Non-Urgent (I can wait a month or longer for placement of this cat).
Should be Empty:

Intake Triage Form

Tell Us About Yourself

Pet 1 Information

Pet 2 Information

Pet 3 Information

Pet 4 Information

Pet 5 Information

Lifestyle Information

Resources

Final Information