Owner's First and Last Name*
Best Phone Number to Contact you at*
Dogs Name you are surrendering*
Describe your dogs coat. (Rough, Smooth). Please tell us about their coloring and if your dog has been tattooed and/or microchipped.
What do you feed your dog and how many times a day? Please include if they have any allergies.*
Why are you seeking rehoming for your dog?*
What is your dogs current vet's name, address and phone number?*
Date of last Rabies Vaccination*
Date of last Distemper vaccination?*
Date of last heartworm test?*
If you dog is currently heartworm positive, has medication been given?
Is your dog currently on flea and tick preventative medication? If yes, when was the last Flea/Tick preventative medicine given?*
If you dog is a puppy, when was the last date of their 5 and 1 shot?
Has your dog been checked for hip dysplasia? Type N/A if not*
Has your dog ever been xrayed and if so, for what purpose?*
Does your dog have any other medical conditions/treatments?
Does your dog jump fences?*
Does your dog have any bad habits? If yes, please decribe*
Has your dog been exposed to cats?*
If your dog has been exposed to cats or rabbits what is there reaction?
Has your dog been exposed to other dogs?*
If your dog has been exposed to other dogs, what was their reaction? Would you decribe their behaivior good , bad or unknown?*
Has your dog been raised around children?
If your dog has been raised around children would you describe their behavior good, bad or unknown? What ages are the children?*
Does your dog show preference to*
Is your dog house broken?*
If housebroken, what is the signal when your dog wants to go outside?
Does your dog ever have accidents?*
Has your dog been used for breeding?*
Does your dog ride well in the car?*
Has your dog recieved obedience training?*
Has your dog ever bitten anyone?*
If you dog has bitten or nipped someone in the past, please explain the circumstances:
Has your dog ever growled or bared its teeth at family members? If yes, please explain the circumstances:P*
Has your dog ever growled or bared it teeth towards strangers? If so, please explain the circumstances:*
Does your dog show any protectiveness towards it's food or toys? If yes, please explain:*
Please share any special things your dog enjoys?*
Is there anything else your dog likes or dislikes you would like to share?
