Your Name (required)
Your Home/Cell Phone Number (required)
Your Work Phone Number
Your Email (required)
What kind of pet?
How old is the dog/cat?
Has the cat/dog ever bitten?
If so, what were the circumstances to the bite?
Are you the owner and have a valid ID?
Please selectNoYesOther (see below)
If you selected other, please provide details.
What is prompting you to surrender the pet?
What is the pet's name?
How long have you had this pet?
Is it already spayed/neutered?
Please selectNoYesDon't Know
Has your dog been tested for heartworm?
If so, date of last test?
Has your cat been tested for FIV/FELV?
Who is your pet's regular veterinarian? Please provide contact information.
Does the pet have any known health issues or areas of concern?
Does the pet have any behavioral issues or concerns?
Please provide pictures of the animal.
Please provide vet records showing status of vaccines, age of spay/neuter status, and rabies certificate signed by the vet.