Cat Surrender Questionnaire

Pixie is able to take owner-surrendered cats as time and circumstances allow. Please provide as much information as you can about health and behavior. Filling out this form does not guarantee that Pixie is able to accept your cat into our adoption program, but we will be in contact within two days. (Pixie is closed to the public Sunday and Monday.)

Your Contact Information

Your Name (required)

Your Email (required)

Your Address (required, street + city + state + zipcode):

Telephone (required)

Tell us about your cat.

An astrick (*) indicates required fields.

Cat's Name*:

Age*:

Cat's Gender (M/F):

Is the cat up-to-date on shots/vaccines*?

Does the cat have any known health issues*? (if yes, explain below in "other")

Is the cat fixed?*

Has the cat been tested for FIV/Felv*? (If yes, what were the results?)

Where did you get the cat?*

How long have you had the cat?*

Reason for surrender?*

Timeline for surrender?*

How does the cat do with other cats?*

What does the cat do when meeting new people?*

Has the cat ever been around kids? Dogs?*

Is the cat indoor/outdoor or both?*

Any other behavioral notes?

Other:




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    510 N.E. MLK Blvd.
    Portland, OR 97232

    Retail: (503) 542-3432
    Adoption: (503) 542-3433
    Fax: (503) 542-3437

    Hours:
    Tuesday-Friday 11:00 - 6:00
    Saturday 11:00 to 4:00