Owner Surrender Appointment Request Form

If you have exhausted all other options and would like to make an appointment to surrender your pet, please fill out this form in its entirety.

 

    Owner Name*
    Address Line 1*
    Address Line 2
    City*
    State*
    Zip Code*
    Phone Number*
    Email Address*

    Pet Name*
    Type of Animal*
    DogCatOther
    Gender*
    MaleFemale
    What breed or mix?*
    Age of Animal*
    Is the animal spayed or neutered (i.e. fixed)?*
    YesNo
    Is the animal up-to-date on shots?*
    YesNo
    Why do you want to give up this pet (please describe in detail)?
    How long have you had the pet?
    Where did you get the pet from originally?
    Is the animal sick, injured or does it have any health problems?
    YesNo
    If yes, please describe the health problem
    Please describe the pet’s temperament
    FriendlyAggressiveShyOther
    Has the animal ever lived with other animals?*
    YesNo
    Is the pet good with children?
    YesNo
    Is the pet good with dogs?
    YesNo
    Is the pet good with cats?
    YesNo
    Where does the animal stay during the day?
    Where does the pet stay at night?
    If it is a dog, is it housebroken?
    YesNo
    If it is a cat, is it having litterbox problems?
    YesNo
    Has the pet ever shown signs of aggression to people?
    YesNo
    If yes, please explain circumstances
    Has the pet bitten anyone within the past 10 days?
    YesNo
    Do you currently have any other pets in the home?*
    YesNo
    If you have a digital picture of your pet and can send it to us, please upload it here