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Cat (or Other) History Form

Along with the PALS volunteer form, you will need to fill out this form for you cat if you wish for him or her to participate in pet therapy visits. There is an online form or one you can print and fill out on paper.

If you prefer a printable form please download the (pdf) or word document. Then mail or fax it to PALS. Thank you.

Owner / Handler

First Name
Last Name
Phone/Fax
Email

Animal's Bio

Name
Date of Birth (or estimated)
Breed(s) of cat (or species, if not a cat)
Gender
 Female 
 Female-Spayed 
 Male 
 Male-Neutered 
Age when acquired
How did you acquire your them?
If the cat was NOT a kitten, what do you know of its history?
What type of collar do you most commonly use?
Is your cat used to walking on a leash?
YES
NO
Is cat fully house trained?
YES
NO
What is your cat's reaction to: (Check ALL that apply)
A) Other cats:
Playful
Chases
Accepts Calmly
Nervous
Afraid
Aggressive
No Experience
A) Dogs:
Playful
Chases
Accepts Calmly
Nervous
Afraid
Aggressive
No Experience
C) Children:
Playful
Chases
Accepts Calmly
Nervous
Afraid
Aggressive
No Experience
D) Vets Office:
Playful
Chases
Accepts Calmly
Nervous
Afraid
Aggressive
No Experience
Any other unusual reactions (i.e. men, uniforms, hats, people with canes)?
Has your cat ever scratched or bitten anyone?
YES
NO
If YES, please provide detailed explanation:
Which veterinary clinic do you use?
Currently rabies vaccinations are mandatory for all pets accepted into our program. Do you provide this protection for your cat?
 YES
 No, but I will, so that my application can be processed
Has your cat had surgery in the last 6 months?
YES
NO
If YES, please provide detaileds:
Is your cat on any medication?
YES
NO
If YES, please provide detaileds:
Has your cat ever been in a fight with another animal or had any experience which you may consider traumatic?
How does your cat fair riding in the car?
Bad
Poor
Average
Fair
Good
List things your cat does NOT like:
Please detail any behavioral problems you have encountered with your cat:
Is there any additional information you would like to add?