Cat Profile

Contact Information

First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
-

Email*

Home Phone

Work Phone
x

Cell Phone

*=required

Profile Form Date

Mailing Address if Different from Above

Can you keep the pet until it is adopted?

Yes

About the Cat

Cat Name:

Formerly Known as:

Rescue ID (EAPL admin use only)

Does your pet have special needs

What Breed is your pet

Pet Gender

Male

Female

Declawed:

Yes

Weight (pounds):

Age

Reason you are giving up the pet:

Did the pet come from out-of-state?

Yes

If so, which state?

Ideal adoptive home:

No Dogs	No Cats
Designated Cat

Medical Information

Vet Name:

Veterinarian Phone:

Recent Vet Visit?:

Is the pet spayed or neutered?

Yes

Alter date

Vaccination dates?

FIV/Leukemia testing dates?

FIV/Leukemia testing results?

Does the pet have any old injuries or health problems?

Yes

If yes, please describe:

Current health concerns?:

Does the pet need any medication or special diet?:

Yes

If yes, please describe:

When was the pet usually fed:

AM	PM
Free Fed	Other

What do you feed the pet?

Are there any special dietary concerns?

Living Environment

How long have you had the pet?:

Where Acquired:

How much of the time was the pet outside?

How much of the time was the pet inside?

Where did you leave the pet when you were gone on holiday/vacation?

Is the cat litterbox trained?

Yes

Litterbox training comments:

If there are litterbox problems, has the cat been seen by a vet to rule out physical issues?

Yes

Behavior

Gets Along With:

Dogs

Cats

Good With Children:

Yes

Good With Children Comments:

Good With Adults:

All	Men Only
Women Only

Concerns:

Administrative Use

EAPL Tag Number:

form completed

Yes

EAPL Representative Who talked to you:

EAPL Representative Comments:

*=required