Cat Information Survey

   
This form can be completed for a number of situations:

1) Rehome your cat/kitten using FieldHaven's website/ Courtesy List and/or to bring your cat to one of our adoption venues for adoption. NOTE: your cat/kitten must be spayed/neutered and up to date on vaccines, etc.


2) Request consideration of your cat  for intake into FieldHaven


3) Request assistance or referral for a a stray cat/kitten you are trying to find placement for.


4) Behavior assistance is needed to help resolve an issue you are having with your cat so that it may stay in your home.  

Please indicate below which option you are interested in.


If the cat is a rescue just complete as much as you can on this survey.  We understand that you may not know all your rescue's personality traits.


FieldHaven's capacity for bringing cats into our shelter is driven by adoptions;  when 1 cat gets adopted that makes room for 1 needy cat to come to FieldHaven.  We receive multiple requests each day to take cats in.  We truly wish we could have room for every cat but we do not so we evaluate and triage each request to come up with an action plan.  We will work with you to explore solutions other than surrendering your cat to a shelter if that is possible.  We are very creative!    




   
CIS (Cat Information Survey) Category

   
Category

    ____ Courtesy List

____ Apply for Owner Surrender to FieldHaven

____ Stray that I am looking to rehome

____ Rescue Assistance

____ Behavior Assistance


If you want to surrender your cat/kitten to FieldHaven are you able to provide financial assistance?



    ____ Yes
____ No


Comments

    _______________________________________________

_______________________________________________

_______________________________________________


Your Information

   
Full Name:

    _______________________________________________


Address:

    _______________________________________________

_______________________________________________


City:

    _______________________________________________


State:

    _______________________________________________


Zip Code:

    _______________________________________________


Phone:

    _______________________________________________


Email:

    _______________________________________________


Please explain why you are rehoming this cat?

    _______________________________________________

_______________________________________________

_______________________________________________


If you could find a solution would you be willing to keep your cat?  

    ____ Yes
____ No
____ N/A-this cat is a rescue that I'm trying to find a home for


Cat Information and Medical History

   
How long have you owned your cat?

    _______________________________________________


Cat's Name

For multiple cats list information on all of them in the spaces below

    _______________________________________________

_______________________________________________


Description (breed, color, etc)

    _______________________________________________


Date of Birth (or approximate age)

    _______________________________________________


Gender

    ____ Male
____ Female


Is your cat spayed or neutered?

    ____ Yes
____ No
____ Not Sure


Is your cat up-to-date on the FVRCP and/or Rabies Vaccines?:

    ____ FVRCP (combo vaccine)
____ Rabies


Has your cat had a FeLV/FIV test done?

    ____ No
____ Yes


Is your cat microchipped?

    ____ No
____ Yes
____ Not sure


Is your cat declawed?

    ____ Not declawed
____ Front declawed
____ All 4 declawed


Please provide any information you can about your cat's medical history.

    _______________________________________________

_______________________________________________

_______________________________________________


Do you have copies of current veterinary records?

    ____ No
____ Yes


Current Vet/Clinic and Phone Number

    _______________________________________________

_______________________________________________


Personality Traits

(complete only what you know if this cat is a rescue you are looking for help with)

   
How would you describe your cat's personality? (Check all that apply)

    ____ Friendly/Social

____ Feral/Semi Feral

____ Very Active

____ Couch potato

____ Talkative

____ Quiet

____ Playful

____ Friendly to Family

____ Shy to Family

____ Affectionate

____ Overtimulates easily

____ May nip/scratch if overstimulated

____ Lap Cat

____ Friendly to Visitors

____ Fearful to Visitors

____ Independent

____ Solitary

____ Gets along with kids

____ Gets along with other cats

____ Gets along with dogs

____ Not kid friendly

____ Not cat friendly

____ Not dog friendly


Please provide any additional information you can about your cat's personality.

    _______________________________________________

_______________________________________________

_______________________________________________


Where does your cat primarily live?  (check all that apply)

    ____ Indoors only

____ Outdoors only

____ Indoors at night

____ Garage or basement

____ Indoors with access to outside

____ In barn or shed



Comments on your cat's living environment

    _______________________________________________

_______________________________________________

_______________________________________________


How would you describe the ideal home for your cat?

    _______________________________________________

_______________________________________________


Please tell us some things you truly love about this cat!

    _______________________________________________

_______________________________________________


Are there any quirks or habits you are not fond of in your cat?

    _______________________________________________

_______________________________________________


Does your cat have any litterbox issues?

    ____ Yes

____ No


If yes, please describe

    _______________________________________________

_______________________________________________

_______________________________________________


Description and Biography

   
Please give us your best description of this cat.  What is his/her "story"?    What type of disposition does s/he have?  Any information your can provide to assist us with helping you and the cat.

    _______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________


Do you want your cat to be placed on the waiting list to come into FieldHaven's shelter should space become available?

    ____ Yes
____ No
____ Maybe


Thank You!    We look forward to helping you

We receive multiple requests each day so it may take us several days to review your information.  We will evaluate your Cat Information Survey and contact  you soon.

Any medical records or other documentation can be faxed to 916-644-6415 or mailed. Please send any digital photos to [email protected]