Pets In Crisis Cat Intake Questionnaire About You Who are you completing this form for? * Myself I am a Case Worker completing this form on behalf of a client OtherOther Your name: * Safe number: * Safe email: * Do you currently have a fixed address? * Yes No If yes, please provide your safe address below: Which suburb do you currently reside in? * Alternate contact's name: Alternate contact's number: Case worker’s name: Case worker’s number: Case worker’s email: About Your Cat Name: * Breed: * Age: * Sex: * Female Male Weight (kg) If you don't know, please estimate Colour: * Date of last vaccination: * Microchip number (if known): * Are they sterilised? * Yes No Unsure If your cat is female and unsterilised, when was she last in season? Who is currently caring for your cat, and where are they located? * Where did you obtain your cat? How long have you had your cat for? If your cat has any medical conditions, please detail below: * e.g. itchy skin, allergies, ear infection, sensitive tummy, etc. If your cat is receiving any medical treatments or medication, please detail below: The Home Environment What kind of living situation do you usually have? * Apartment/flatTown houseHouse with small yardHouse with large yardFarmI am currently staying with friends/ family Do you have children in your household? If so, how old are they? * On a daily basis, what percentage of time does your cat spend indoors vs outdoors? * Does your cat use a litter tray? * Yes No On average, how many hours per day is your cat left alone? * Where does your cat spend most of their time when left alone? * Where does your cat sleep at night? Is your cat around other animals? If yes, what kind of animals, and how do they interact? * What things does your cat like or enjoy? * e.g. being tickled under the chin, etc. What things does your cat NOT like or enjoy? * e.g. being touched on the ears, etc. Please list anything your cat is scared of: * E.g. loud noises, thunderstorms, fireworks, etc. Are there any other behaviour concerns we should be aware of? * Additional comments Is there anything else you'd like us to know about your cat? Submit
