Portland – Small Pet Intake - Oregon Humane Society

Your Name*

First Last

Phone Number*

Email*

Address

Street Address Address Line 2 City 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*

Pet's Name*

Age*

Pet's Gender*

Male
Female

Is the pet spayed/neutered?*

Yes
No

How 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
No

If 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
No

If 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
No

If no, what happens when you try?*

How long can you hold this pet?*

Where was this pet mainly kept?*

Indoors
Outdoors

Describe this pet's housing (cage, hutch, etc.):*

Is this animal litter box trained?*

Yes
No

What is your pet's current diet? (Check all that apply)*

When do you feed? (Check all that apply)*

AM
PM
Free feed

Does this pet prefer their water from:*

Water bottle
Floor bowl

This animal is compatible with (check all that apply):*

If other, who is this pet also compatible with?*

How would you describe this pet? (Check all that apply)*

What are this pet's favorite toys?*

What does this pet like to chew on?*

Does this pet have any known illnesses or conditions?*

Yes
No

If yes, please explain:*

Has this pet seen a vet in the last year?*

Yes
No

If 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?

We rely on donations in order to offset daily cost of care for each animal. Please provide the amount you can comfortably afford to donate to help support us in caring for your pet. $__________

If you require language interpretation services, please select your preferred language below.

Small Animal Intake Form