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Irvine Animal Care Center

animalcare@cityofirvine.org

6443 Oak Canyon Irvine, CA 92618

949-724-7740

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.

Gender


QUESTIONNAIRE

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):

WHO LIVES WITH YOUR CAT NOW?

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


RELATIONSHIP WITH CATS

Has your cat lived with other cats?

Do the cats get along (select one):

CAT/CAT AGGRESSION


OTHER PETS

Has your cat lived with dog(s)?

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


LITTERBOX

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?


HEALTH

Does your cat have any current health issues?

I acknowledge the above information is true to the best of my knowledge. I give permission to the Irvine Animal Care Center to contact my veterinarian and obtain my pet's medical history.

Sign Here

Choose how to sign

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.