Name:
Address:City, State, Zipcode
phone:
email:
Are you the legal owner of this dog?
Why are you giving up your dog? Be specific and detailed.
How soon must you surrender the dog?
Are you able to provide a tax-deductible donation to help us defray your dogs expenses?
What is your dogs name?
what is your dogs age?
What is your dogs color?
Do you have AKC papers?
Who was the breeder?
If you don't know the breeder, where did you get this dog and are you the original owner?
Is your dog a mix?
Does your dog have any health concerns at all no matter how small?
Does your dog limp, have seizures, diabetic, difficulty walking?
Does your dog have any wounds, growths to be removed?
Has your dog had a dental cleaning?
Does your dog have infected ears?
Is your dog spayed/neutered? Can you supply a spay/neuter certificate?
Is this dog up to date on rabies? Can you supply a rabies certificate?
is this dog up to date on other vaccines? Can you provide us a record of those from your vet?
Will you give permission to your vet to release medical records to us for our use in taking care of your dog?
Is your dog microchipped? What is the chip number.
How is your dog with other dogs both big and small?
Does your dog need to be an only dog? Why?
Is your dog good with cats? How do you know this?
Does your dog sleep inside or outside?
Is your dog housebroken?
Has your dog been crate trained?
What is your dogs energy level from hyper to high, to semi high to very low. Be as accurate as possible.
how much exercise do you give each day and what kind?
How is your dog on the leash?
How is your dog in the car?
How is your dog with children?
How is your dog with strangers?
Is your dog a barker?
Is your dog a chewer?
Is your dog afraid of anything or is he/she shy or timid?
Does your dog have separation anxiety?
How is your dog when left alone inside the house?
Is your dog possessive over food or toys?
Has your dog ever bitten or tried to bite a human OR a dog? What happened? Did you file a bite report?
Has your dog ever killed or injured a chicken, cat, or other critter?
Any habits or quirks we should know?
Thanks for all the information and we'll get with you shortly!