Pet Retention / Surrender Assistance Form

Please complete this survey and a pet retention specialist will be in touch to review your case.

Surrendering a pet is never an easy decision. Please know that if you find you are no longer able to keep your pet, you have options. We are here to help.

Please complete the following survey, be as detailed and complete as possible. This will help us best help you.

Once submitted, a pet retention specialist will be in touch to review your case and help guide you towards the appropriate resources.

If this is a safety concern or medical emergency, please call us at 703-777-0406.

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* 1. What is your name?

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* 2. What is your address? To receive services from Loudoun County Animal Services you must reside in Loudoun County. You will need to provide proof of residency (ex, driver's license, utility bill) at time of appointment.

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Please tell us a bit about your household. This helps us better understand your pet's current living situation and offer specific resources.

Number of adults in household

Number of children in household (please list ages)

Type of home (townhouse, single family, fenced yard etc)

Other animals in home

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* 4. Are you at least 18 years old?

Yes

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* 5. Are you the only owner of the animal? If there is a co-owner, former owner etc please indicate below.

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* 6. Are you looking for euthanasia / end of life support for your pet?

Yes