Portland – Small Pet Intake

Small Animal Intake Form POQ – April 2023

"*" indicates required fields

Your Name*
Address
Pet's Type*

Use if the animal is over 1 years old, otherwise leave as 0
Use if the animal is over 3 months old, otherwise leave as 0
Use if the animal is below 3 months old, otherwise leave as 0
Pet's Gender*
Is the pet spayed/neutered?*
Has this pet ever bitten?*
Are there any places on this pet's body that it does not like to be touched?*
Can you pick up and hold this pet?*
Where was this pet mainly kept?*
Is this animal litter box trained?*
What is your pet's current diet? (Check all that apply)*
When do you feed? (Check all that apply)*
Does this pet prefer their water from:*
This animal is compatible with (check all that apply):*
How would you describe this pet? (Check all that apply)*
Does this pet have any known illnesses or conditions?*
Has this pet seen a vet in the last year?*
Please only include numbers. No symbols or letters. ex: I want to donate $150, I would put 150 in the box
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This field is for validation purposes and should be left unchanged.