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Irvine Animal Care Center

6443 Oak Canyon Irvine, CA 92618


COMMUNITY SERVICES | Irvine Animal Care Center

Cat Owner Surrender Questionnaire/Medical History Consent Form

To provide the best care for your pet, it is necessary to have your pet's behavioral and medical histories available for review. Please complete the following information so we may get to know your pet better and obtain their medical records from your veterinarian. Signing this form does not waive or reduce any fees past or present from the Irvine Animal Care Center.



Is your cat spayed/neutered?

Is your cat declawed?

Where does your cat live?

How would you describe your cat (check all that apply)?

My cat likes (check all that apply):

My cat does not like (check all that apply):

How does your cat behave around strangers in the home (check one)?

Would you describe your home as (select one):


How does you cat get along with the people in your household (select one)?


Has your cat lived with other cats?

Do the cats get along (select one):



Has your cat lived with dog(s)?

Has your cat lived with animals other than cats and dogs?


Has your cat had any issues using the litter box?

Is your cat (check all that apply):

What type of litter box do you have (check all that apply):

Have you tried other types of litter?

If yes, what have you tried (check all that apply)?

Has your cat ever seen a veterinarian for these issues?

If yes, were there any medical issues?


Does your cat have any current health issues?

Upload Your Documents

A valid government photo ID, proof of City of Irvine residency, and proof of pet ownership must be submitted to move forward with the owner surrender process.  Medical records are highly recommended.

Valid Government Photo ID

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Proof of Irvine Residency

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Proof of Pet Ownership

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Medical Records

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I acknowledge the information provided is true to the best of my knowledge.

I authorize the Irvine Animal Care Center to contact my veterinarian and obtain my pet(s) medical records.

I understand that by relinquishing my pet(s), I am relinquishing all interest in and ownership of my pet(s) to the Irvine Animal Care Center. I release the Irvine Animal Care Center and the City of Irvine from any claims, present or future, related to the disposition of the animal(s), which may include euthanasia.

I understand that I am responsible for all fees required to relinquish my pet(s).

I understand that all fees are due prior to the pet(s) relinquishment. Owners unable to afford the required fees may apply for financial hardship support. Contact the Irvine Animal Care Center for more information and application. Once an application is completed, the decision making process may take up to two business days. The process must be completed prior to the pet(s) relinquishment.

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The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject-matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, all information provided on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, businesses or individuals.