Owned Cat Intake Profile Owned Cat Profile Form OWNED CAT INFORMATION PROFILE This form is designed to help determine what will be in the best interest of your cat and to assist our staff in understanding your cat more. To help us learn more about your cat, please fill out this form completely. Please understand that the cat's welfare must and will always be our foremost consideration. Therefore, the Humane Society will not release information on this cat after it has been released to us. OWNER'S INFORMATIONFirst Name*Last Name*Email* Phone Number*Owner's Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CAT'S GENERAL INFORMATIONCat's Name*Cat's Age*Is your cat’s age an estimated age?* Yes No Gender of Cat* Female Male Is your cat fixed?* Yes No I Don't Know CAT'S GENERAL HISTORYWhere did you get your cat?*How long have you owned your cat?*Why are you needing to give your cat up?*Is there anything that would enable you to keep your cat? If yes, please tell us what.*Has your cat lived with (Check all that apply):Adult MenAdult WomenTeenagersChildrenToddlersBabiesDoes your cat get along with everyone in your household? Please explain.Has your cat lived with other cats? Yes No If yes, how many other cats?Did they get along? Please describe their interactions.Has your cat lived with dogs? Yes No If yes, how many dogs?Did they get along? Please describe their interactions.ENVIRONMENT AND PERSONALITYWhere does your cat spend most of his/her day? (inside, outside, in a specific room, etc.)Does your cat spend time outdoors? Yes No When indoors, where does your cat spend most of his/her time?How long is your cat left alone without people on an average day?What is your typical routine of activities with your cat each day?What type of food do you feed your cat and how often is he/she fed? Is food available all the time or at set "mealtimes"?What are your cat’s favorite foods?How would you describe your cat’s personality?In general, does your cat like to be petted?YesNoSometimesWhere and how does your cat like to be petted?Where and how does your cat NOT like to be petted?Does your cat like to be picked up? Yes No Does your cat like to sit on your lap? Yes No Does your cat like to play? Yes No If yes, please describe how/what he likes to play.Does your cat like to play with toys? What type?Does your cat use scratching posts?YesNoSometimesWhere does your cat usually sleep at night?Has your cat ever shown any growling, hissing, or mouthing/biting towards you or anyone else? If so, when?What do you like best about your cat?What are your cat’s favorite things?What is your cat afraid of? Are there things your cat does not like or is afraid of? If so, please describe.Does your cat have any bad habits (such as scratching on furniture, escaping from the house, waking you up at night, knocking things off counters, etc.)? If yes, please describe his/her bad habits.How have you addressed these and did you find anything that helped?LITTER BOX TRAINING HISTORYHow would you describe your cat's litter box training?Great, not having any accidentsOK, only rare accidents (less than once a month)Could be better, a few accidents each week ChoiceAwful - most elimination is happening out of the boxIf your cat eliminates outside of the box is it:UrineFecesBothHow long has this problem been going on?Has your cat seen a vet for this problem, what did the vet suggest?How have you tried to address this problem? Did anything you have tried help?How many litter boxes are in the home and where are they located?What is the size and type of litter boxes (covered, uncovered, automatic, oval, large rectangular, etc)?What type of litter do you use and what brand? (scented or unscented, clumping versus clay)How often do you scoop the litter box?How often do you change it completely?HISTORY OF MEDICAL ISSUESDoes your cat see a veterinarian? If yes, who?How does your cat behave during veterinary visits?Does your cat have any past or present medical problems? If yes, please describe.Is your cat on any medications? If yes, please describe.Has your cat shown any of these signs:CoughingSneezingItchingDiarrheaVomitingLack of AppetiteNone of the AbovePlease select all that applyAny change in grooming or sleeping habits?Any change in water or food consumption?Any change in frequency of urination or defecation?