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Cat Owner Questionnaire

This form has been modified since it was saved. Please review all fields before submitting.

Steps

1. Please read carefully This section is complete This section is incomplete
2. Owner Information This section is complete This section is incomplete
3. General Information This section is complete This section is incomplete
4. Medical History This section is complete This section is incomplete
5. Home Environment This section is complete This section is incomplete
6. Dietary Habits This section is complete This section is incomplete
7. Litter box habits This section is complete This section is incomplete
8. Additional Information This section is complete This section is incomplete

Please read carefully

No one knows and loves your cat the way you do! In order to find the most appropriate home for your cat, please provide as much detail as possible about history, past veterinary care, likes, dislikes and quirks of your feline friend.

Behavioral and medical issues do not necessarily create problems, but failing to disclose them certainly does. We want to ensure your cat/s finds a forever home!
Please note: Submitting this questionnaire online is NOT a confirmation of an appointment. To schedule an appointment to surrender an animal, please call the shelter during business hours at (859) 356-7400 to speak with a staff member.
Continue

Owner Information

Name*
Email Address*
Address*
City*
State*
Zip Code*
Phone Number*
Alt. Phone Number
Animal ID (for staff use only)
Has your cat bitten in the last ten days?*
1. Yes
2. No
Continue |Go Back

General Information

Application Submission Date
Application Submission Date
Cat's Name*
Cat's Age*
(or approximate)
Cat's Sex*
1. Male
2. Female
3. Unsure
Is cat spayed/neutered?*
1. Yes
2. No
3. Unsure
What kind of ID does your cat have?
1. Tattoo
2. Microchip
3. None/Other/Unknown
Where is the tattoo located?
Is cat declawed?
1. Front
2. All
3. Not Declawed
When was cat declawed?
1. As a kitten
2. As an adult
3. Unknown
Why are you surrendering your cat?*
If surrender reason is behavioral, please explain.
If we could help you resolve this issue would you be interested in keeping the cat?
1. Yes
2. No
How long have you owned your cat?*
Including yours, how many homes has this cat had?*
Continue |Go Back

Medical History

Did the cat see a veterinarian at least once per year?*
1. Yes
2. No
3. Not Sure
If so, which clinic?
Is this cat current on vaccinations?*
1. Yes
2. No
3. Not Sure
Has this cat ever had surgery?*
1. Yes
2. No
3. Not Sure
If yes, please explain.
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
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.
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
If Other, please describe:
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
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
Continue |Go Back

Home Environment

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
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
If other areas of home, please describe:
If other locations, please describe:
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
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
If other interactions with cats, please describe:
If other interactions with dogs, please describe:
Has the cat regularly been around children?*
1. Yes
2. No
3. Unsure
If yes, indicate what ages.
1. 0-2 yrs
2. 3-5 yrs
3. 6-10 yrs
4. 11-18 yrs
Have the experiences with the cat and child(ren) always been positive?
1. Yes
2. No
If no, please explain:
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
If other interaction with child, please describe:
Is this cat more comfortable with:
1. Women
2. Men
1. Kids
2. Teenagers
1. Seniors
2. Loves all people
How would you describe the ideal home for your cat?
Tell us some things you love about this cat.
Are there any quirks or habits you are not fond of in your cat?
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
How did you attempt to correct this problem?
Other cat behaviors:
Continue |Go Back

Dietary Habits

Which does your cat eat?
1. Dry Only
2. Canned only
3. Combination of dry & canned
4. People food
What is your cat’s favorite brand of food?
How frequently is your cat fed?
1. Food always available
2. Designated mealtimes
What type of treats does your cat enjoy?
Continue |Go Back

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.
Does your cat have access to a litter box in the house?
1. Yes
2. No
If no, did your cat use the bathroom outdoors?
1. Yes
2. No
3. Sometimes
Is the litter box:
1. Covered
2. Uncovered
Where is the litter box(s) located in the house?
Does your cat have litter box accidents?*
1. Yes
2. No
3. Sometimes
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
How often does your cat have litter box accidents?
If other type of accident, please describe.
How often was litter box scooped?
1. Every day
2. Every few days
3. Weekly
4. Rarely
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
If other type of litter, please describe.
Are there other animals in your home? *
1. No
2. Other cats
3. Dogs
4. Birds
5. Rodents
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
If litter box accidents were an issue, when did they begin?
1. Past month
2. Past year
3. Ongoing
Can you pinpoint an event(s) that might have influenced or triggered inappropriate litter box use?
Please describe the measures you have taken to correct this problem.
Has your cat been to the veterinarian to rule out infection or underlying health issues?*
1. Yes
2. No
What was the outcome?
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Additional Information

Please tell us any additional comments about your feline friend.

Leave This Blank:

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

This field is not part of the form submission.
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* indicates a required field

Contact Us

Kenton County Administration
1840 Simon Kenton Way
Covington, KY 41011

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