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