Portland – Small Pet Intake Small Pet Personality Your Name* First Last Phone Number*Email* Address Street Address Address Line 2 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 Please choose why you are filling out this form.* I have a small pet I am fostering. I have a small pet I am surrendering.What is your foster pet's ID number?*Pet's Type* Rabbit Guinea Pig Rat Hamster Chinchilla/Degu Bird Pet's Name*Age*Pet's Gender* Male FemaleIs the pet spayed/neutered?* Yes NoHow long have you fostered this pet?*How long have you owned this pet?*Where did you acquire this pet?*Has this pet ever bitten?* Yes NoIf yes, what were the circumstances?*Why do you need to rehome this pet?*Are there any places on this pet's body that it does not like to be touched?* Yes NoIf yes, please explain where on the body and what they do when touched in that area.*Can you pick up and hold this pet?* Yes NoIf no, what happens when you try?*How long can you hold this pet?*Where was this pet mainly kept?* Indoors OutdoorsDescribe this pet's housing (cage, hutch, etc.):*Is this animal litter box trained?* Yes NoWhat is your pet's current diet? (Check all that apply)* Pellets Alfalfa hay Seed Fresh fruit Fresh veggiesWhen do you feed? (Check all that apply)* AM PM Free feedDoes this pet prefer their water from:* Water bottle Floor bowlThis animal is compatible with (check all that apply):* Young children (babies/toddlers) Older children/Teens Visitors Same species as pet Cats Dogs OtherIf other, who is this pet also compatible with?*How would you describe this pet? (Check all that apply)* Playful Affectionate Outgoing Shy Easy-going Lap pet Active IndependentWhat are this pet's favorite toys?*What does this pet like to chew on?*Does this pet have any known illnesses or conditions?* Yes NoIf yes, please explain:*Has this pet seen a vet in the last year?* Yes NoIf yes, what vet office did you go to?*How did your pet react at the vet?*Is there anything else you would like us to know about this pet?