How many years has this cat lived with you?
Where did you acquire this cat?
If another shelter/rescue please list group’s name, state, city
Description/ Color Markings:
Rabies & Other Vaccination Information
Last time this cat went to the vet:
Does this cat have any health issues or old injuries?
Is this cat on any medication or supplements?
Is this cat on a special diet or have dietary issues?
When is this cat usually fed?
What BRAND and flavor/name of food was the cat fed?
Does the cat have any favorite toys or activities?
Where has this cat been living?
How much time was the cat kept... (in hours)
Where does the cat stay when no one is home?
How many hours per day on average does this cat spend unsupervised?
Where is this cat used to sleeping at night?
What ages of people lived with this cat?
If you checked the box that indicates that the animal has lived with children, please answer the following two questions:
What are the ages of the children?
How would you describe the cat's behavior around children?
How would you describe your household?
How does the cat react to visitors?
Does this cat use a litter box?
How often does the cat have accidents in the house?
If there are potty issues has the cat seen a vet to rule out a medical issue?
Actions taken to correct this:
Has your cat ever been diagnosed with Urinary Crystals/Stones?
What type of litter do you/have you used?
Is this cat used to SHARING a litter box with other cats?
How many cats are there? How many litter boxes?
Has this cat ever bitten or badly swiped/clawed anyone intentionally?
Does the cat use a scratching post and/or cat tree?
Does the cat scratch the furniture?
This cat is used to being allowed on:
This cat LIKES petting on:
This cat DISLIKES petting on:
Does this cat have any bad habits a new owner should be aware of?
What did you do to correct the problem?
Is this cat frightened of anything?
What other animals has this cat lived with?
Does the cat have issues with any animals?
Is this cat a hunter/mouser?
Does the cat have any favorite toys or activities?
Which words best describe this cat?
This cat is accustomed to:
Is there anything else we should know about this cat?
Do you understand that CASA charges a surrender fee to help cover the cost of care? Are you able to pay the surrender fee. ($100 Altered $200 Unaltered) ($0 for puppies, kittens and moms)
My submitting this form, I attest that the above given information is true and to the best of my knowledge. I am the owner of the above-described cat and have the legal authority to surrender/transfer ownership said cat to another party such as C.A.S.A. I give CASA permission to obtain all veterinary records related to the animal listed above. I also understand that upon surrendering this animal to CASA, CASA becomes the legal owner of this animal and will make any and all decisions regarding their being.
Staff Use Only - Fee, Scheduling and Wait times.
