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Irvine Animal Care Center

6443 Oak Canyon Irvine, CA 92618


COMMUNITY SERVICES | Irvine Animal Care Center

Dog Owner Surrender Questionnaire/Medial 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 informaiton so we may get to know your pet better an obtain their medical records from your veterinarian. Signing this form does not waive or reduce any pet fees past or present from the Irvine Animal Care Center. 


Household type


Is your dog spayed/neutered?

Are you the first owner?

Do you have other pets?

Where does your dog live?

Is your dog crate trained?

Is your dog house trained?

Has your dog had obedience training?

Does your dog go to the dog park?

Can your dog walk on a leash?

Has your dog ever seriously bitten or scratched anyone?

Is your dog relaxed when left alone?


If you are experiencing problems with house training, answer the following questions.

Does your dog urinate, defecate, or both inside your home?

Has your dog been checked by a veterinarian to rule out medical problems that could cause this problem?


If you are experiencing problems with barking, answer the following questions. 

Does your dog bark while on walks?

Does your dog bark at visitors?


If you are experiencing problems with destructiveness, answer the following questions. 

Does your dog inflict injury on himself by:


If you are experiencing problems with escaping, answer the following questions.

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.