Intake Questionnaire You are requesting to surrender an animal to the Lake Humane Society?*YesNoIs this a stray cat? (Stray dogs can be surrendered to the Lake County Dog Warden.)*YesNoYour Name*Phone Number*Address*Email Address (Please note: The Intake Coordinator will contact you via this email address)*Animal(s) NamesType of Animal(s)*Breed or MixAge of Animal(s)What is the reason for bringing this pet in?*Who currently owns this pet? Where did the pet come from?*Is the pet spayed or neutered?*Any medical conditions or medications?*Is the pet up to date on vaccines?*YesNoUnsureDo you have access to the pet's medical records?*YesNoUnsureWhat is the general personality of this pet? Likes/dislikes?*Is this pet good with other animals, like dogs and cats?*Has this animal ever been in a fight with another animal? If so, describe the circumstance.*Has this animal ever bitten a person? If so, describe the circumstance.*Has this pet been exposed to small children?*YesNoUnsureDoes this pet have separation anxiety?*YesNoUnsureDoes this pet have any behavioral problems? If so, please describe.*Please provide any other important information not included above.If possible, please upload a photo of this animal. Drop files here or Select filesMax. file size: 10 MB.