Salem – Cat Intake Salem Campus Intake - Cat Personality "*" indicates required fields General InformationCat's name* HiddenCat’s age or approximate age Cat's age in years*01234567891011121314151617181920212223242526272829+Use if the animal is over 1 years old, otherwise leave as 0Cat's age in months*01234567891011Use if the animal is above 3 months old, otherwise leave as 0Cat's age in weeks*0123456789101112Use only if the animal is below 3 months old, otherwise leave as 0Cat's breed Cat's sex* Male Female Unsure Is your cat spayed/neutered? Yes No Unsure Does your cat have a microchip? Yes No Unsure Is your cat declawed? Yes No When was the cat declawed? As a kitten As an adult How 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/ Relative Unintended Offspring Other Shelter/Rescue Organization* Has your cat bitten anyone or any animal?* Yes No Did this incident break skin? Yes No Has your cat bitten anyone or any animal in the last ten (10) days?* Yes No Did this incident break skin? Yes No HistoryWhy 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 No When 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? Is your pet currently taking any prescribed medications?* Yes No Please list all current medications Has your pet been diagnosed with a chronic medical condition that requires ongoing medical care?* Yes No Please describe the Pet's medical condition Are there places on this cat’s body where they do not like to be touched? Yes No If 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 play What 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 No If yes, what kind? Cardboard Rope Carpet What areas of your home did the cat have access to? Indoors only Outdoors only Indoor/Outdoor Does your cat live with any of the following: Dogs (Large) Dogs (Small) Cats Small Animals Livestock Children What are the ages of the children? Would you recommend placing this cat in a home with cats?* Yes No What 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 No What 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 No What 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 No Is the litter box: Covered Uncovered How often was the litter box scooped? Every day Every few days Once a week What type of litter(s) was used? Unscented Scented Clumping Non-clumping Crystals Clay Pellet Select AllHow many cats shared the litter box? Does your cat urinate or defecate outside of the litter box? (litter box misuse) Yes No Where does the misuse occur? Urinates/defecates on furniture Urinates/defecates on clothing Urinates/defecates on humans bed Sprays on walls/furniture Other If 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 No How 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* The average daily cost for caring for each animal we receive is $150. We ask for a donation from each family using our services to help us in caring for your pet. Please indicate the amount you can comfortably afford to donate. Every dollar helps!*Please only include numbers. No symbols or letters. ex: I want to donate $150, I would put 150 in the boxIf you require language interpretation services, please select your preferred language below. Arabic Cantonese French German Italian Japanese Korean Mandarin Persian Portuguese Russian Spanish Vietnamese Other PhoneThis field is for validation purposes and should be left unchanged.