Salem – Cat IntakeSalem Campus Intake - Cat Personality General InformationCat's name*Cat’s age or approximate age*Cat's breedCat's sex* Male Female UnsureIs your cat spayed/neutered? Yes No UnsureDoes your cat have a microchip? Yes No UnsureIs your cat declawed? Yes NoWhen was the cat declawed? As a kitten As an adultHow long have you owned this cat?Where did you acquire this cat?* Oregon Humane Society – Portland Campus Oregon Humane Society – Salem Campus Other Shelter/ Rescue Organization Found as Stray Breeder/ Pet Store Private Party/ Courtesy Posting Family/ RelativeOther Shelter/Rescue Organization*Has your cat bitten anyone or any animal?* Yes NoDid this incident break skin? Yes NoHas your cat bitten anyone or any animal in the last ten (10) days?* Yes NoDid this incident break skin? Yes NoHistoryWhy are you rehoming your cat?If we could help you resolve this issue, would you be interested in keeping the cat?What would you like new owners to know about this cat?Has your cat ever been seen by a veterinarian? Yes NoWhen was the last time your cat went to the vet?What was the name of the clinic?How did this cat react to going to the vet?Are there places on this cat’s body where they do not like to be touched? Yes NoIf yes, where and what do they do?Home Life, Training & MannersHow would you describe your cat most of the time? (check all that apply) Affectionate Playful Lap cat Friendly with visitors Shy with family Shy with visitors Independent Very active Not very active Feisty Uses mouth/claws in playWhat are your cat’s favorite things to do? i.e. favorite toys, treats and/or activities.What is your cat’s favorite food or treats?Does your cat use a scratcher? Yes NoIf yes, what kind? Cardboard Rope CarpetWhat areas of your home did the cat have access to? Indoors only Outdoors only Indoor/OutdoorDoes your cat live with any of the following: Dogs (Large) Dogs (Small) Cats Small Animals Livestock ChildrenWhat are the ages of the children?Would you recommend placing this cat in a home with cats?* Yes NoWhat reason(s) would you recommend placing this cat in a home with cats?What reason(s) would you not recommend placing this cat in a home with cats?*Would you recommend placing this cat in a home with dogs?* Yes NoWhat reason(s) would you recommend placing this cat in a home with dogs?What reason(s) would you not recommend placing this cat in a home with dogs?*Would you recommend this cat be around children regularly?* Yes NoWhat reason(s) would you recommend placing this cat in a home with children?What reason(s) would you not recommend placing this cat in a home with children?Does your cat have access to a litter box in the house? Yes NoIs the litter box: Covered UncoveredHow often was the litter box scooped? Every day Every few days Once a weekWhat type of litter(s) was used? Select All Unscented Scented Clumping Non-clumping Crystals Clay PelletHow many cats shared the litter box?Does your cat urinate or defecate outside of the litter box? (litter box misuse) Yes NoWhere does the misuse occur? Urinates/defecates on furniture Urinates/defecates on clothing Urinates/defecates on humans bed Sprays on walls/furniture OtherIf you chose other, please describe where the misuse occurs.Can you pinpoint an event that might have triggered the misuse?Has this cat been seen by a vet to rule out any possible underlying health issues? Yes NoHow long has litter box misuse been occurring?Were there any changes in the home that may have caused the litter box misuse?How often does litter box misuse occur?Your InformationYour name* First Last Please enter your address below* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your phone number*Email*PhoneThis field is for validation purposes and should be left unchanged.