Kitten Surrender Profile
[pic]
Puppy Surrender History
Animal Information
Animal Name: _______________________________
Sex (circle one): Female Male Spayed/Neutered (circle one): Yes No
Age: ______________________ Date of birth (if known): ________________________
Animal History
How long have you owned this puppy? _________________________________________________
Where did you obtain the puppy? _____________________________________________________
Why are you surrendering your puppy? _________________________________________________
________________________________________________________________________________
Where did the puppy spend most of its time? Indoors Outdoors Both
Children: ( Lived with ( Visited with ( Never been around ( Seen outside
Cats: ( Lived with ( Visited with ( Never been around ( Seen outside
Dogs: ( Lived with ( Visited with ( Never been around ( Seen outside
Small animals: ( Lived with ( Visited with ( Never been around ( Seen outside
How does the puppy behave and/or interact with the following?
Adults |Kids under 7 |Kids 7+ |Strangers |Other cats |Dogs |Vet office | |( Friendly |( Friendly |( Friendly |( Friendly |( Friendly |( Friendly |( Friendly | |( Playful |( Playful |( Playful |( Playful |( Playful |( Playful |( Playful | |( Plays Rough |( Plays Rough |( Plays Rough |( Plays Rough |( Plays Rough |( Plays Rough |( Plays Rough | |( Cuddly |( Cuddly |( Cuddly |( Cuddly |( Cuddly |( Cuddly |( Cuddly | |( Vocal |( Vocal |( Vocal |( Vocal |( Vocal |( Vocal |( Vocal | |( Tolerates |( Tolerates |( Tolerates |( Tolerates |( Tolerates |( Tolerates |( Tolerates | |( Hides |( Hides |( Hides |( Hides |( Hides |( Hides |( Hides | |(Aggressive |( Aggressive |( Aggressive |( Aggressive |( Aggressive |( Aggressive |( Aggressive | |
Animal Care
How often do you feed your puppy? ___________________ per day
What type of food does the puppy eat?
( Canned puppy food Brand:
( Dry puppy food Brand: _________
Is the puppy house trained? Yes No Partially Is the puppy crate trained? Yes No Partially
Does the puppy know any commands? Sit Down Stay Come Fetch Shake Other: _________
What are your puppy’s favorite toys? ___________________________________________________
Animal Health
Name of Veterinary Clinic puppy has been to: ___________
First and last name on the account at the vet’s office: _____________
Last time the puppy was seen by the vet: _____ __
Please list any brand of flea or heartworm preventative this puppy has received: __________________
Date flea/heartworm preventative was given: ____________________________________________
Is the puppy microchipped? ( NO ( YES: Name of company: ___________________________
Does your puppy have any known health concerns? ________________________________________________________________________________________________________________________________________________________________
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