Connecticut Humane Society – Feline Foster Report Card

Cat’s Name: ______ID#: ______Employee Conducting the Intake:

The following questionnaire is used to help us find the best possible home and prepare your pet’s new family with information about his/her history. Please complete this questionnaire as completely and accurately as possible.

HOUSEHOLD INFORMATION AND SOCIAL BEHAVIOR:

1.When you first brought your foster cat home, how did it react?  Friendly /outgoing  Shy  Liked to hide

2. After adjusting to your home, how was your foster cat?  Friendly/outgoing  Shy  Liked to hide

3. Including yourself, please record all individuals who lived with this cat and their age range:

Name/Relationship
(first name only please) / Age Range
(0-7) (8-15) (16-21) (21-65) (65+) / Gender / Notes

4. Did your foster cat interact with other pets in the home?  Dogs (note breed/sex/age):

 Cats  Birds  Small Animal  Reptile  Other:

  • 5. How did your fostercattypically behave toward the following? Please check the boxes.

Unknown / Friendly / Fearful / Growls / Bites / Other
People your cat knows
Men
Women
Children
Unfamiliar people
Men
Women
Children
Animals your cat knows
Dogs
Cats
Unfamiliar animals
Dogs
Cats

If other is checked for any category, please specify and explain:

  • 6. How would you describe your foster cat’s personality? Check all that apply.  Playful  Couch Potato  Vocal

 Friendly  Shy  Independent  Fearless  Fearful  Quiet  Affectionate  Hyper  Aloof

 More like a dog  Outgoing  Lap cat  Aggressive  Other:

  • 7. How does your foster cattypically respond when an unfamiliar person approaches or enters the house?

 Friendly Scared Hides Indifferent Affectionate  Other:

8. How active is this cat?  Very active  Somewhat active  Inactive

9. How vocal is this cat?  Very vocal  Somewhat vocal  Non-vocal

10. Where does this cat like to be pet? Head Back Rump  Tail  Feet  Ears  Other:

11. Does this cat like to be picked up? Yes NoDetails:

12. What best describes your home? Busy – people always coming and going Quiet – someone is always home  Empty – I am rarely home  Average – I am home and away 50/50

 Other:

ROUTINE AND HABITS:

  • 1. Does this cat use a litter box?  Yes  No

If no, where does this cat go to the bathroom?

  • 2. Did your foster cat have accidents in the house?  Yes, urinates  Yes, defecates  Yes, both  No

How often?  Daily  Weekly  Once in a while

3. When did this behavior first occur?

4. What has been done so far to correct the problem?

  • 5. Does this foster cat like to play (check all that apply)? No interest in play  Chases bugs  Will fetch

Plays rough, may scratch/bite Plays with toys Plays gently Plays in water  Plays with dogs

 Plays with cats  Likes laser pointers  Like wand/feather toys  Other:

6. Was your foster cat allowed on furniture?  Yes  NoCountertops?  Yes  No

  • 7. Was the foster cat destructive?  No  Chews wires  Scratches furniture  Scratches carpets

 Chews/eats plants  Other:

8. What have you done to deter this behavior and was it successful?

______

  • 9. Does this cat have any bad habits or unique behaviors a future adopter should know about?

______

10. Please include any other pertinent routine information: ______

______

  • BEHAVIOR:

1. Has your cat ever bitten anyone?  Yes  No Date of the bite:

Please describe:

2. If yes, did this bite break skin?  Yes  NoDetails:

3. Has thecat ever attacked another animal?  Yes  No Details:

ADOPTION MEMO:
Please write a few sentences about your cat for use in their Adoption write-up.

______

______

______

STAFF ONLY BELOW THIS POINT

BEHAVIORAL INTAKE SUMMARY

O/G Surrender / Witness / No Admit/Request / Evaluator:
Category / Range / A / B / C / D / F / Range
Social Int. / Friendly / Aggressive
Body Lang. / Soft eyes/body / Lunging/Growling/Snapping
Stress Level / Calm / Shedding/Displacing/Avoidance
A = Gentle, friendly, head butting, purring, can handle and move cat about easily, friendly in cage.
B = May not solicit, but enjoys interaction, may be more shy than an A cat, easy to handle. Scared in cage, but does not aggress.
C = Crying, pupils dilated, much more scared than a B cat, shedding, trying to hide or escape.
D = Stiffens, freezes, cautious, hissing. May try to bolt or refuse to leave carrier. Hissing in cage. Difficult to handle.
F = Lunging, striking in cage, attempts to bite. Aggressive in cage, cannot handle safely.
For Intake History, record owner responses below.
Loves Children / Has / Will Lunge Or Show Aggression
Intake Hist. / Loves Dogs / Has / Will Attack Dogs
Loves Cats / Has / Will Attack Cats
Uses Litter Box / Never uses litter box
Notes: