Survey - Pet Guardianship Questionnaire: Cat

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Question - Required - Today's Date:

Month

Day

Year

YOUR INFORMATION

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Name:

Title	First Required	Last Required

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Email: Required

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Street 1: Required

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City/State/ZIP:

City Required	State Required	ZIP Required

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Mobile Phone: Required

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Question - Required - How many adults in the household?

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Question - Required - How many children in the household?

Question - Not Required - Please list ALL other pets residing in your home with whom THIS CAT had contact. Include other pets' species/breed, age, gender, and whether they are spayed/neutered. Also include other pets' relationship with this cat:

YOUR CAT'S INFORMATION

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Question - Required - Breed (Persian, Siamese, mix, etc.):

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Question - Required - Cat's Name:

Question - Not Required - List any nicknames that your cat responds to:

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Question - Required - Cat's Gender:

Male

Female

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Question - Required - Is your cat spayed/neutered?

Question - Not Required - Please provide your cat's microchip number (if applicable):

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Question - Required - Cat's Age (approximately):

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Question - Required - Cat's age when you adopted it (approximately):

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Question - Required - How long have you owned this cat?

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Question - Required - Where did you acquire this cat?

Animal Control

Born at Home

Breeder

Friend / Family

Gift

Newspaper Ad

Pet Store

San Diego Humane Society

Shelter, Rescue, or Other Humane Agency

Stray / Found

Other

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Question - Required - Does your cat have a preference for:

	Men
	Women
	Children
	Other Cats
	Dogs
	Other Animals

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Question - Required - How would you describe this cat, in general?

	Aggressive
	Calm
	Clingy
	Confident
	Cuddly
	Curious
	Dependent
	Excitable
	Fearful
	Friendly
	Happy
	Independent
	Nervous
	Outgoing
	Playful
	Shy
	Smart
	Stand-Offish
	Stubborn
	Submissive
	Vocal
	Other

BEHAVIOR INFORMATION

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Question - Required - How does this cat behave with ADULT members of the household? Select all that apply:

	Aggressive
	Calm
	Cuddly
	Destructive
	Excited
	Fearful
	Friendly
	Indifferent
	Playful
	Plays Gently
	Plays Roughly
	Protective
	Shy
	Vocal

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Question - Required - How does this cat behave with CHILD members of the household? Select all that apply:

	Aggressive
	Calm
	Cuddly
	Destructive
	Excited
	Fearful
	Friendly
	Indifferent
	Playful
	Plays Gently
	Plays Roughly
	Protective
	Shy
	Vocal
	Not Applicable

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Question - Required - How does this cat behave with ADULT visitors to the home?

	Aggressive
	Calm
	Cuddly
	Destructive
	Excited
	Fearful
	Friendly
	Indifferent
	Playful
	Plays Gently
	Plays Roughly
	Protective
	Shy
	Vocal

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Question - Required - How does this cat behave with CHILD visitors to the home?

	Aggressive
	Calm
	Cuddly
	Destructive
	Excited
	Fearful
	Friendly
	Indifferent
	Playful
	Plays Gently
	Plays Roughly
	Protective
	Shy
	Vocal
	Not Applicable

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Question - Required - How does this cat behave with ADULT strangers? Select all that apply:

	Aggressive
	Calm
	Cuddly
	Destructive
	Excited
	Fearful
	Friendly
	Indifferent
	Playful
	Plays Gently
	Plays Roughly
	Protective
	Shy
	Vocal

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Question - Required - How does this cat behave with CHILD strangers? Select all that apply:

	Aggressive
	Calm
	Cuddly
	Destructive
	Excited
	Fearful
	Friendly
	Indifferent
	Playful
	Plays Gently
	Plays Roughly
	Protective
	Shy
	Vocal

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Question - Required - Does this cat enjoy being held, hugged, or handled?

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Question - Required - Has this cat ever bitten anyone?

Question - Not Required - If yes, please explain. If this cat gives "love bites," please note that here as well, and include how soft or hard these "love bites" are:

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Question - Required - What makes your cat anxious or worried, or causes it to behave in a different manner than usual?

	Baths
	Brushing
	Car Rides / Getting Into the Car
	Cats
	Cat Carrier
	Children
	Crowds
	Dogs
	Fireworks / Loud Noises
	Getting Nails Trimmed
	Men
	Nothing
	Other Animals
	Strangers
	Vet Visits
	Women
	Other

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Question - Required - Does this cat use a scratching post?

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Question - Required - What type of surface does this cat prefer to scratch on?

	Cardboard
	Carpet
	Sisal Fiber
	Upholstery
	Wood
	Other

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Question - Required - When scratching, does this cat prefer surfaces that are:

	Horizontal
	Vertical
	Slanted on an Angle
	No Preference

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Question - Required - Is this cat territorial?

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Question - Required - Does this cat display predatory behaviors?

	Ambushing
	Bird Watching
	Fly/Spider Chasing
	Stalking
	Other
	None

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Question - Required - This cat's energy level is:

Very High

High

Medium

Moderate

Low

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Question - Required - Does this cat have any areas it prefers not to be touched?

	Abdomen
	Back
	Ears
	Face
	Feet
	Neck
	Tail
	Other
	None

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Question - Required - This cat is most active:

Morning

Afternoon

Evening

Night

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Question - Required - Does this cat display any of the following "don't pet me" behaviors?

	Flattens Ears
	Narrows Eyes
	Ripples Back
	Swishes Tail
	Twitches Ears
	Other
	None

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Question - Required - Describe your cat's play intensity:

Low / Gentle

Moderate

Medium

High

Very High / Rough & Tumble

Not Interested

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Question - Required - List your cat's favorite toy(s):

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Question - Required - Activities you do with your cat:

	Bathing / Grooming / Brushing
	Games
	Petting
	Quiet Companionship
	Relaxing / Snuggling
	Restaurants / Cafes
	Road Trips / Running Errands
	Training
	Walking on a Lead or Harness
	Other

HOUSING AND FEEDING INFORMATION

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Question - Required - This cat is an:

Indoor Cat

Outdoor Cat

Indoor and Outdoor Cat

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Question - Required - Where is this cat when you are HOME?

Free Access Inside and Outside

Inside

Outbuilding (garage, barn, shed, etc.)

Outside

Semi-Outdoors (screened patio, fenced cat area, etc.)

Other

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Question - Required - Where is this cat when you are OUT?

Free Access Inside and Outside

Inside

Outbuilding (garage, barn, shed, etc.)

Outside

Semi-Outdoors (screened patio, fenced cat area, etc.)

Other

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Question - Required - Where does this cat sleep at night?

	Inside Alone
	Inside with Person/People
	Inside with Other Animal(s)
	Outbuilding (garage, shed, etc.) Alone
	Outbuilding (garage, shed, etc.) with Other Animal(s)
	Outside Alone
	Outside with Other Animal(s)

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Question - Required - Is this cat a picky eater?

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Question - Required - What type / brand of food does this cat eat? Please specify dry or wet food, and include the brand and any other info:

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Question - Required - How often do you feed this cat?

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Question - Required - What amount is fed per feeding?

Question - Not Required - List any of this cat's favorite treats:

LITTER BOX INFORMATION

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Question - Required - Number of cats in home:

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Question - Required - Number of litter boxes in home:

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Question - Required - What room(s) is the litter box in?

	Bathroom
	Bedroom
	Garage
	Kitchen
	Laundry Room
	Living Room / Family Room / Den
	Office
	Other

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Question - Required - Type of litter box:

	Covered
	Electronic Self-Scooping
	Rolling
	Uncovered
	Other

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Question - Required - Type of Litter:

	Clay, non-clumping
	Clumping / Scoopable
	Crystals / Pearls
	Sand
	Scented
	Shredded Newspaper
	Unscented
	Other

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Question - Required - How much litter?

1-2 inches

2-3 inches

3-4 inches

4+ inches

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Question - Required - Do you use litter box liners?

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Question - Required - What items, if any, are near the litter box?

	Cat's Bed
	Cat's Food
	Scratching Post
	Other
	None

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Question - Required - When does this cat have accidents?

	Frequently
	Only When Left Alone
	Rarely
	Never

Question - Not Required - Accidents Are:

Urination

Bowel Movements

Both

Question - Not Required - Has the cat seen a vet for the accident problem?

Question - Not Required - If yes, what was the result?

Question - Not Required - Are accidents:

	In Same Room as Litter Box
	Next to Litter Box
	In Another Room
	Near a Door or Window

Question - Not Required - Soiled Surfaces:

	Bath / Shower
	Carpet
	Cat's Bedding
	Clothing
	Concrete
	Linoleum
	Paper
	People's Bedding
	Plastic
	Tile
	Upholstered Furniture
	Wood
	Other

Question - Not Required - Is there anything else we should know about this cat's litter box preferences or habits?

VETERINARY INFORMATION

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Question - Required - Has this cat had routine vet care?

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Question - Required - Is this cat de-clawed?

Front

Back

Front and Back

No

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Question - Required - Has this cat been vaccinated for:

	FIV
	FIP
	FeLV
	None

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Question - Required - Has this cat been diagnosed with:

	FIV
	FIP
	FeLV
	None

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Question - Required - How does this cat behave at the vet's office?

	Anxious
	Bites
	Calm / Relaxed
	Hisses
	Indifferent
	Must be Restrained
	Must be Sedated
	Scratches
	Other

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Question - Required - Vet's Name (first and last):

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Question - Required - Name of Vet Office / Practice:

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Question - Required - Vet's Phone Number:

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Question - Required - May we call your vet for information regarding this cat?

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Question - Required - Has this cat received notable veterinary treatment? This does NOT include regular check-ups and care:

Question - Not Required - If yes, please explain:

Question - Not Required - List and explain any medical issues / treatments / care / medications that we should know about:

ADDITIONAL INFORMATION

Question - Not Required - Please list any additional info regarding this cat's daily routine. Include any need-to-know details for walking, feeding, grooming, bathroom time, etc.

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Question - Required - What do you enjoy most about this cat?

Question - Not Required - List and explain any special needs this cat has or any special attention that this cat requires:

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Question - Required - Describe the ideal home you would like for this cat:

Question - Not Required - List any additional info that would be helpful for us or a new owner to know about this cat. This will help us make the best possible match with a new home.