Rabbit/Critter Surrender Questionnaire

If you are human, leave this field blank.

First Name *

Last Name *

Physical Street Address *

To create your file and begin the surrender process, the WHS must have your physical address. Please do not use your PO Box.

City *

Postal Code *

Email *

Primary Phone Number *

Secondary Phone Number

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Has the pet bitten a human in the last 10 days?

Name

Age

Breed

Sex

Is the pet spayed or neutered?

Does the pet have a tattoo?

If the pet has a tattoo, what is the number?

Where did you get the pet?

How long have you had the pet?

Why are you surrendering the pet?

This pet is used to living:

Is this pet litter box trained?

Does this pet have a favourite game and/or toy?

If yes, what is it?

Does this pet like to sit on your lap?

How much time did this pet have outside of its cage each day?

Does this pet enjoy or tolerate being held by children?

If yes, what were the ages of the children?

Was this pet exposed to any other animals?

Dogs

Cats

Rabbits

Does the pet have any health issues you are aware of?

If yes, please describe:

Are there any wonderful, special traits or habits you would like his/her new family to know about?

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