Feline Surrender Profile

Feline Profile

The following questionnaire provides Elmbrook Humane Society (EBHS) with more information about your cat in order to learn more about his/her behavior. Because your cat is likely to behave in similar ways in his/her new home, this information helps us find the most suitable match for your cat. Your open and honest answers are necessary and appreciated.

Surrender Reason

Please describe why you are applying to surrender your cat to EBHS. * Required
If help could be provided with remedying the reason for surrender, would you be open to keeping the cat? * Required
- Yes
- No
- Possibly
Were you referred by a person or business? * Required
- Yes
- No
Who referred you?
Owners Information
Name * Required
First Last
Date application submitted * Required
MM slash DD slash YYYY
Address * Required
Street Address City State ZIP Code
Phone/Type (primary) * Required
Phone/Type (secondary)
Email * Required
Animal Information
Name * Required
Breed * Required
Age * Required
Sex * Required
- Male
- Female
Altered * Required
- Yes
- No
Color * Required
Declawed? * Required
- Yes
- No
Is he/she: * Required
- Declawed in the front only
- Four paw declawed
Age of your cat when declawed * Required
- As a kitten
- As an adult
- Already declawed when acquired
Where did you get your cat from? * Required
- EBHS
- Friend/Relatives
- Newspaper/Online
- Found/Stray
- Breeder
- Pet store
Another Shelter/Rescue: * Required
Other (please describe): * Required
How long have you had your cat? * Required
Including yours, how many homes has your cat had? * Required
Household Information
Please list all people currently living in your home:
Click "+" to add more people
First Name Last Name Age
Are there children living in your home? * Required
- Yes
- No
How does your cat react to the children? * Required
- Friendly/Social
- Shy/Scared
- Tolerant/Indifferent
Please list all companion animals that your cat has lived with or is currently living with: * Required
Click "+" to add more animals
Name Breed Age Sex Altered? (Yes or No) Declawed? (Yes or No) Still in Home? (Yes or No)
- No other animals in the household
Did your cat get along with other pets/animals? * Required
- Yes
- No
- Sometimes
What would you consider the activity level in your household to be like? * Required
- A library
- Middle of the road
- A carnival
Typical Behaviors/Tendencies
Does your cat ever eliminate outside of the litterbox? * Required
- Yes
- No
How often? * Required
Does your cat urinate only, defecate only, or both? * Required
- Urinate
- Defecate
- Both
How long has your cat been inappropriately eliminating? * Required
Where does your cat eliminate other than the litterbox? * Required
What have you tried to help correct the inappropriate elimination? * Required
Have you been to the vet to rule out infection or any underlying healthy issues? * Required
- Yes
- No
What type of litter does your cat prefer? * Required
- Clay
- Clumping
- Shavings
- Pellets
What brand of litter does your cat prefer? * Required
How many litterboxes do you have? * Required
Where are they located? * Required
What type of litterbox does your cat prefer? * Required
- Covered
- Uncovered
Does your cat ever spend anytime outside? * Required
- Yes
- No
Please describe * Required
Where does your cat spend most of his/her time? * Required
- Inside the house, free roam
- Inside the house, confined to a specific area
- Outside, free roam
How long is your cat left alone during the day? * Required
- Never left alone
- 1-3 hours
- 4-8 hours
- 9-12 hours
- 12+ hours
Where does your cat usually sleep at night? * Required
Is your cat allowed on the furniture? * Required
- Yes
- No
Is there anywhere your cat does not have access to jumping on? * Required
What are your cat’s bad habits, if any? * Required
Does your cat have a scratching post? * Required
- Yes
- No
What type of scratching post? * Required
Does your cat have an allotted space/item he/she can use to scratch? * Required
- Yes
- No
What/where? * Required
Is your cat talkative? * Required
- Yes
- No
Does your cat like to purr? * Required
- Yes
- No
If your cat had a career what would it be? * Required
Why? * Required
How does your cat usually react when you or another family member does the following (please check in all that apply)?
Bath * Required
- Never tried
- Enjoys
- Allows
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Brush * Required
- Never tried
- Enjoys
- Allows
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Hold * Required
- Never tried
- Enjoys
- Allows
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Hug * Required
- Never tried
- Enjoys
- Allows
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Pick up * Required
- Never tried
- Enjoys
- Allows
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
How does your cat usually behave toward the following (Please check all that apply)?
People your cat knows
Men * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Women * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Children * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Unfamiliar People
Men * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Women * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Children * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Familiar Animals
Dogs * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Cats * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Unfamiliar Animals
Dogs * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
Cats * Required
- Never encounter
- Friendly
- Afraid
- Hisses/Growls
- Scratches
- Bites
- None
If your cat has bit, did the bite break skin? * Required
- Yes
- No
Was the bite reported? * Required
- Yes
- No
Did the bite require medical attention? * Required
- Yes
- No
Please explain circumstances of the bite(s) * Required
What toys does your cat like to play with? * Required
- Balls
- Mice
- Wand
- Laser
- String
- None
- Other
Other * Required
What is your cat’s favorite thing to do? * Required
Describe your cat’s activity level: * Required
- Very active
- Moderately active
- Couch Potato
Does your cat exhibit any anxiety over anything? * Required
- Yes
- No
Please describe * Required
What are your cat’s top 3 best qualities?
1. * Required
2. * Required
3. * Required
Would you describe your cat as: * Required
- More social
- More independent
On a scale from 1-10 how would you rate your cat’s level of affection? * Required
- 1-not affectionate
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10-super affectionate
Medical History
Does your cat see a veterinarian at least once a year? * Required
- Yes
- No
Veterinary Clinic Name * Required
Contact Info * Required
When was the last time your cat saw a veterinarian? * Required
Is your cat current on his/her vaccines? * Required
- Yes
- No
How does your cat usually behave while at the vet for the following procedures (Check all that apply)?
Wellness exam * Required
- Hisses/Growls
- Scratches
- Bites
- None
- Unknown
Restraint * Required
- Hisses/Growls
- Scratches
- Bites
- None
- Unknown
Vaccination * Required
- Hisses/Growls
- Scratches
- Bites
- None
- Unknown
Nail trim * Required
- Hisses/Growls
- Scratches
- Bites
- None
- Unknown
Blood draw * Required
- Hisses/Growls
- Scratches
- Bites
- None
- Unknown
Ear cleaning * Required
- Hisses/Growls
- Scratches
- Bites
- None
- Unknown
Does your cat have any past or present medical conditions? * Required
- Yes
- No
Please describe medical conditions * Required
Is your cat currently on any medication or special diet? * Required
- Yes
- No
Please describe * Required
What type of food does your cat eat? * Required
- Kibble
- Canned
- Raw
What Brand? * Required
Is your cat a good eater? * Required
- Yes
- No
Please explain * Required
How often is your cat fed per day? * Required
- Once
- Twice
- More than twice
- Free-fed (food out all day)
Signature * Required
Date * Required
MM slash DD slash YYYY

Give Us a Call:

Office Hours:

Viewing Hours:

Feline Surrender Profile

Feline Profile

Surrender Reason

Owners Information

Animal Information

Household Information

Typical Behaviors/Tendencies

People your cat knows

Unfamiliar People

Familiar Animals

Unfamiliar Animals

Medical History

262-782-9261

262-782-3356

Elmbrookhs@ebhs.org

First Name	Last Name	Age

Name	Breed	Age	Sex	Altered? (Yes or No)	Declawed? (Yes or No)	Still in Home? (Yes or No)