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Name
*
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Last
Email
*
Phone
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
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Afghanistan
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Virgin Islands, U.S.
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Pet Information
Type of Animal
*
Dog
Cat
Critter
Dog Questionnaire
Pet's Name
*
Breed
*
Pet's Age
*
Pet's Gender
*
Pet's Approximate Birth Date
*
Spayed/Neutered
*
Yes
No
Microchipped
*
Yes
No
Color(s)
*
Last Vaccination Date
*
Name of Regular Veterinarian
Has Your Pet Ever:
Growled
Snapped
Bitten a person
Please check all that apply.
If you checked any of the above, please describe the incident(s):
Please describe any bad habits or medical issues that a new owner should be aware of:
How long have you had this pet?
*
To your knowledge, how many previous owners has this pet had?
*
Where did you acquire them?
*
Breeder
Friend/Relative
Found Stray
Born at Home
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The Humane Society for Tacoma & Pierce County
Other Rescue/Shelter
What kind of training has your pet had?
*
Obedience Class
Home Training
Professional Training
None
Does your pet know how to:
Sit
Stay
Come
Lie Down
Walk on Leash
Other
Check all that apply.
Is your pet crate trained?
*
Yes
No
If yes, how long can they comfortably stay in the crate:
Where do you leave your dog when they are alone?
*
Indoors unconfined
Indoors in a crate
Indoors confined in a room
Outside unconfined
Outside in fenced yard or dog run
Outside on rope/chain lead
Indoors with access to outdoors
In barn or shed
In garage or basement
At doggie day-care
With owner at work
Check all that apply.
How many hours per day on average does your pet spend alone?
*
Where does your dog sleep?
*
Indoors unconfined
Indoors confined in crate/room
Outside
Garage or Basement
Check all that apply.
Is your dog housebroken?
*
Yes
No
How do you know when your dog needs to go to the bathroom?
Please describe how often your pet eats, how much, and the brand of food given:
*
Does your pet get along with other dogs?
*
Yes
No
If no, what do they do around other dogs?
Does your pet get along with cats?
*
Yes
No
If no, what do they do around cats?
My pet has lived with:
Other Dogs
Cats
Caged Animals
Livestock
Other
Check all that apply.
Has your dog ever killed or injured another animal?
*
Yes
No
If yes, please explain:
My dog has:
*
Lived with children
Regularly visited children
Has infrequent contact with children
No experience with children
Negative experience with children
Check all that apply.
If there has been a negative experience with children, please explain:
What are your dog’s BEST qualities?
*
How would you describe your dog’s personality?
*
What are your dog’s favorite activities?
*
What would your dog’s ideal home be like?
*
My pet's energy level is:
*
Low
Average
High
How much exercise does your dog need regularly?
*
Lots
Moderate
Little or none
Is your dog used to grooming?
*
Yes
No
Unknown
If yes, who has groomed them? (i.e. yourself, grooming professional)
Are you able to trim your dog’s nails?
*
Yes
No
Unknown
How do they react to nail trims?
Cat Questionnaire
Pet's Name
*
Breed
*
Pet's Age
*
Pet's Gender
*
Is your pet spayed/neutered?
*
Yes
No
Is your pet microchipped?
*
Yes
No
Is your pet declawed?
*
Yes
No
Color(s)
*
You have owned this animal since (approximate date):
*
Was this cat adopted from The Humane Society for Tacoma & Pierce County?
*
Yes
No
If not, from where did you obtain this cat?
Please list any bad habits or medical issues that a new owner should be aware of:
Current veterinarian/clinic:
Current veterinary clinic address:
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Current veterinary clinic telephone number:
How long has your pet been going to this veterinarian/clinic?
Has your pet ever bitten anyone?
*
Yes
No
If yes, please explain:
My pet lives:
*
Indoors only
Indoors at night
Indoors with access to outdoors
In a barn or shed
In a garage or basement
Other
Check all that apply.
How many hours per day on average does your cat spend alone?
*
Where does your cat sleep?
*
Indoors unconfined
Indoors confined in crate/room
Outside
Garage or basement
Other
Check all that apply.
Do you trust your cat indoors unsupervised?
*
Yes
No
If no, please explain:
Is your cat litter box trained?
*
Yes
No
If no, please explain:
Please identify any other bathroom habits your pet has:
Goes outdoors
Has occasional accidents
Frequent accidents
Sprays
Check all that apply.
Please identify the brand of cat litter your cat prefers:
How would you describe your household?
*
Noisy
Active
Average
Quiet
Check all that apply.
Please explain the amount of food and brand of food provided at each sitting:
*
My cat eats:
*
Once in the morning
Once in the evening
Twice a day
Food left out always
Would you recommend that your cat be placed in a home with children?
*
Yes, any ages of children
Yes, but only children older than a certain age
No
If yes, but only children older than a certain age, please provide the recommended age:
My cat has:
*
Lived with children
Regularly visited children
Has infrequent contact with children
No experience with children
Negative experience with children
Check all that apply.
If lived with children or regularly visited children, please identify their age(s):
If negative experience with children, please identify their age(s):
Your pet's experience with cats:
*
Positive
Negative
No experience
Check all that apply.
Your pet's experience with dogs:
*
Positive
Negative
No experience
Check all that apply.
Your pet's experience with caged animals:
*
Positive
Negative
No experience
Check all that apply.
Your pet's experience with livestock:
*
Positive
Negative
No experience
Check all that apply.
Your pet's experience with other animals (not specified above):
Please explain any significant reaction:
What are your cat’s BEST qualities?
*
Your cat enjoys:
Sleeping on lap
Playing with toys
Other
Check all that apply.
If other, please describe:
Your cat's favorite treats are?
Is your cat a good hunter?
*
Yes
No
If yes, please explain:
Does your cat use a scratching post?
*
Yes
No
If yes, what kind?
Has your cat been vaccinated in the last year?
*
Yes
No
If yes, what vaccines?
Has your cat been tested for FIV & FeLV?
*
Yes
No
If yes, what were the test results?
Positive
Negative
Has your cat been vaccinated for FIV & FeLV?
*
Yes
No
Has your cat received flea treatment?
*
Yes
No
If yes, what kind and when?
Please describe any current medical problems or medications:
Please attach all relevant medical and health records (including vaccination schedules and test results)
Max. file size: 100 MB.
What do you want your cat’s new owners to be like?
*
Critter Questionnaire
Pet's Name
*
Breed
*
Pet's Age
*
Pet's Gender
*
Approximate birth date:
*
How long have you owned this critter?
*
Was your critter adopted from The Humane Society for Tacoma & Pierce County?
*
Yes
No
If not, from where did you obtain your critter?
Does your critter have any bad habits or medical issues that should be known by the new owner?
Is your pet spayed/neutered?
*
Yes
No
Is your pet tattooed?
*
Yes
No
If yes, where?
Is your pet microchipped?
*
Yes
No
If yes, please provide the microchip number:
Current veterinarian:
Current veterinary clinic:
Current veterinarian/clinic address:
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
Current veterinarian/clinic telephone number:
How long has your pet been going to this veterinarian/clinic?
My critter lives:
*
Indoors only
Indoors at night
Outdoor hutch
In garage or basement
Check all that apply.
How many hours per day on average does your critter have interaction with people?
*
If applicable, is your critter litter box trained?
Yes
No
If no, please explain:
Please indicate any other bathroom habits your pet has:
Has occassional accidents
Frequent accidents
Sprays/marks territory
Check all that apply.
If applicable, please identify the brand of litter used:
How would you describe your household?
*
Noisy
Active
Average
Quiet
Check all that apply.
My critter eats:
*
Vegetables
Hay
Pellets
Check all that apply.
If they do eat vegetables, what kind?
My critter drinks from:
*
Water bottle
Water dish
Check all that apply.
What's your critter's experience with children?
*
Positive
Negative
No experience
If any experience with children, please specify ages:
What's your critter's experience with dogs?
*
Positive
Negative
No experience
What's your critter's experience with cats?
*
Positive
Negative
No experience
What's your critter's experience with caged animals?
*
Positive
Negative
No experience
Please explain any negative reactions:
Your critter enjoys:
Interacting with people
Playing with toys
Exploring
Being held
Check all that apply.
How would you describe your critter’s personality?
*
What type of home would your critter do best in?
*
Anything else we should be aware of?
Rehoming Questionnaire Continued
Please describe the primary reason for rehoming your pet:
*
What options have you already explored to find a new home for your pet?
*
Are there resources that would help you keep your pet in your home?
Pet food assistance
Spay/neuter assistance
Veterinary assistance
Behavior guidance
Check all that apply.
Is there any additional information that you would like to share with our Pet Support Team?
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