TPC Waitlist

Name:
E-mail Address: *
Phone Number (With Area Code):
State in which the Pet is Located:
Type of Pet: *	Cat Dog
Size of Pet: *	X-Small (Less than 10 lbs) Small (10-25 lbs) Medium (25-50 lbs) Large (Over 50 lbs)
Breed of Pet: *
Age of Pet: *
Number of Pets: *
Is Pet Current on Vaccines? *	Yes No
If Dog, has Pet tested Negative for Heartworms? *	Yes No N/A
If Cat, is Pet Negative for FeLv and FIV? *	Yes No N/A
Is Pet Spayed or Neutered? *	Yes No
If Cat, is Pet Declawed? *	Yes No N/A
Is Pet Feral? *	Yes No
Is Pet Good With: (Check All That Apply) *	Kids Cats Dogs
List Any Medications the Pet is taking. Leave blank if None.
Please list any Aggressive Behaviors the Pet has. Leave blank if None.
Does Pet have any Dental problems? *	Yes No
Is Pet at Suitable Weight? *	Yes No
If Cat, does Pet have any Litter Box problems? Leave blank if None.
Does Pet have Epilepsy? *	Yes No
Does Pet have Diabetes? *	Yes No
Why are you giving up this Pet?
Are you willing to make a donation towards this Pets continued care? *	Yes No
Additional info:
Attach a Picture of the Pet:


* Required

An Appointment must be set up with our intake coordinator PRIOR to bringing your pet to The Pet Connection.

The Pet Connection is NOT licensed to intake stray pets.

All Missouri pets brought to The Pet Connection must be accompanied by a health certificate or will be subject to an additional $25.00 fee.

If you have any questions about TPC taking in your pet, please contact Melody.