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Cat Owner Questionnaire

2. Name*

3. Email Address*

5. Address*

7. City*

8. State*

9. Zip Code*

11. Phone Number*

12. Alt. Phone Number

14. Animal ID (for staff use only)

15. Has your cat bitten in the last ten days?*

    1. Yes
    2. No

19. General Information:

21. Shelter Arrival Date
    Shelter Arrival Date

22. Cat's Name

23. Cat's Age

    (or approximate)

25. Cat's Sex

    1. Male
    2. Female
    3. Unsure

26. Is cat spayed/neutered?

    1. Yes
    2. No
    3. Unsure

28. What kind of ID does your cat have?

    1. Tattoo
    2. Microchip
    3. None/Other/Unknown

29. Where is tattoo located?

31. Is cat declawed?

    1. Front
    2. All
    3. Not Declawed

32. When was cat declawed?

    1. As a kitten
    2. As an adult
    3. Unknown

34. Why are you surrendering your cat?

36. If surrender reason is behavioral, please explain.

38. If we could help you resolve this issue would you be interested in keeping the cat?

    1. Yes
    2. No

39. How long have you owned your cat?

40. Including yours, how many homes has this cat had?

44. Medical History:

46. Did the cat see a veterinarian at least once per year?

    1. Yes
    2. No
    3. Not Sure

47. If so, which clinic?

48. Is this cat current on vaccinations?

    1. Yes
    2. No
    3. Not Sure

50. Has this cat ever had surgery?

    1. Yes
    2. No
    3. Not Sure

51. If yes, please explain.

53. Where did you acquire this cat?*

    1. KCAS
    2. Another shelter
    3. Rescue organization
    4. Breeder
    5. Born in my home

    1. Newspaper Ad
    2. Friend/Relative
    3. Pet Store
    4. Other

54. Other:

    *If your pet was adopted from another shelter or rescue organization, please contact them prior to scheduling an appointment with us to verify their return policy.

56. Has this cat been diagnosed with and/or treated for any of the following:

    1. Upper Respiratory Infection
    2. Allergies
    3. Heart murmur
    4. Tumors
    5. Epilepsy or seizures

    1. Organ failure
    2. Thyroid disease
    3. Diabetes
    4. Urinary Tract Infection
    5. Other

57. If Other, please describe:

61. Personality

    How would you describe your cat most of the time? (check all that apply)

    1. Friendly to family
    2. Friendly to visitors
    3. Shy to family
    4. Shy to visitors
    5. More like a dog

    1. Very active
    2. Playful
    3. Talkative
    4. Quiet
    5. Fearful

    1. A clown
    2. Aloof
    3. Affectionate
    4. Lap cat
    5. Fearless

    1. Couch potato
    2. Withdrawn
    3. Independent
    4. Playful
    5. Solitary
63. Play Style

    How does your cat like to play? (check all that apply)

    1. Plays gently, does not usually use teeth or claws
    2. Likes to play rough, may bite or scratch
    3. Likes to chase & pounce with variety of toys
    4. Likes things that crackle, such as paper bags
    5. Likes to play hide & seek
    6. Will fetch items like bottle caps or toys

    1. Likes to play with dogs
    2. Likes to play in or around water
    3. Likes to learn tricks for treats
    4. Likes to play with other cats
    5. Not interested in play
    6. Other
67. Home Environment:

69. Where in your home did the cat have access?

    1. Indoors only
    2. Indoors in cold weather
    3. Indoors at night
    4. Indoors with access to outside
    5. Outdoors only

    1. Outdoors in warm weather
    2. Garage or basement
    3. In barn or shed
    4. Screened porch
    5. Other
70. Where did your cat spend most of his or her time?

    1. Bedroom
    2. Kitchen
    3. Living room
    4. Garage or basement
    5. At the window

    1. Outdoors only
    2. Barn or shed
    3. Where people are
    4. Other

72. If other areas of home, please describe:

73. If other locations, please describe:

75. If this cat lived with other cats, how did they interact?

    1. Adored each other
    2. Slept near each other
    3. Fought without injuries
    4. Peacefully coexisted
    5. Played together
    6. Ignored each other
    7. Gentle with others

    1. Sniffed noses
    2. Rough with others
    3. Groomed each other
    4. Fought with injuries
    5. Caused this cat stress
    6. Other

76. If this cat has lived with dogs, how did they interact?

    1. Adored each other
    2. Slept near each other
    3. Fought without injuries
    4. Cat rubbed on dog
    5. Peacefully coexisted
    6. Played together
    7. Ignored each other
    8. Dog chased cat

    1. Cat tormented dog
    2. Sniffed noses
    3. Cat feared dog
    4. Caused this cat stress
    5. Avoided each other
    6. Groomed each other
    7. Fought with injuries
    8. Other

78. If other interactions with cats, please describe:

79. If other interactions with dogs, please describe:

81. Has the cat regularly been around children?

    1. Yes
    2. No
    3. Unsure

82. If yes, indicate what ages.

    1. 0-2 yrs
    2. 3-5 yrs
    3. 6-10 yrs
    4. 11-18 yrs

83. Have the experiences with the cat and child(ren) always been positive?

    1. Yes
    2. No

84. If no, please explain:

86. If this cat lived with children under 7, how did they interact?

    1. Cat actively avoided child
    2. Child could pet cat
    3. Mutual adoration
    4. Ignored each other

    1. Cat & child played together
    2. Cat hissed/growled at child
    3. Other

87. If other interaction with child, please describe:

89. Is this cat more comfortable with:

    1. Women
    2. Men

    1. Kids
    2. Teenagers

    1. Seniors
    2. Loves all people

91. How would you describe the ideal home for your cat?

93. Tell us some things you love about this cat.

95. Are there any quirks or habits you are not fond of in your cat?

97. Does the cat do any of the following?

    1. Jump on counters
    2. Scratch furniture
    3. Chew Plants

    1. Scratches doors/cabinets
    2. Chew personal items
    3. Climb curtains

98. How did you attempt to correct this problem?

100. Other cat behaviors:

104. Dietary Habits

106. Which does your cat eat?

     1. Dry Only
     2. Canned only
     3. Combination of dry & canned
     4. People food

107. What is your cat’s favorite brand of food?

109. How frequently is your cat fed?

     1. Food always available
     2. Designated mealtimes

110. What type of treats does your cat enjoy?

114. Litter Box Habits
     We ask so many questions about litter box use because it is one of the main reasons cats are surrendered. Please help us by giving as much detailed information as possible. Sometimes a change in environment may be just what the cat needs, and sometimes there are more serious health or behavior issues involved.

     We ask so many questions about litter box use because it is one of the main reasons cats are surrendered. Please help us by giving as much detailed information as possible. Sometimes a change in environment may be just what the cat needs, and sometimes there are more serious health or behavior issues involved.

116. Does your cat have access to a litter box in the house?

     1. Yes
     2. No

117. If no, did your cat use the bathroom outdoors?

     1. Yes
     2. No
     3. Sometimes

118. Is the litter box:

     1. Covered
     2. Uncovered

119. Where is the litter box(s) located in the house?

121. Does your cat have litter box accidents?

     1. Yes
     2. No
     3. Sometimes

122. Type of Accidents:

     1. Urinates outside the box
     2. Defecates outside the box
     3. Urinates on clothing
     4. Urinates on furniture

     1. Sprays on walls/furniture
     2. All of the above
     3. Other

124. How often does your cat have litter box accidents?

125. If other type of accident, please describe.

127. How often was litter box scooped?

     1. Every day
     2. Every few days
     3. Weekly
     4. Rarely

128. What type(s) of litter was used?

     1. Unscented
     2. Scented
     3. Clumping
     4. Non-Clumping
     5. Clay

     1. Crystals
     2. Pine
     3. Yesterday's news
     4. Other

129. If other type of litter, please describe.

131. Are there other animals in your home?

     1. No
     2. Other cats
     3. Dogs
     4. Birds
     5. Rodents

132. If other cats, how many shared a litter box?

     1. One
     2. Two or More
     3. Many cats shared
     4. Multiple boxes for multiple cats

133. If litter box accidents were an issue, when did they begin?

     1. Past month
     2. Past year
     3. Ongoing

135. Can you pinpoint an event(s) that might have influenced or triggered inappropriate litter box use?

136. Please describe the measures you have taken to correct this problem.

138. Has your cat been to the veterinarian to rule out infection or underlying health issues?*

     1. Yes
     2. No

139. What was the outcome?

143. Please tell us any additional comments about your feline friend.

Leave This Blank:


145. 1. Receive an email copy of this form.
146. Email address

     This field is not part of the form submission.

147. Submit

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