Pitties.Love.Peace Intake Questionnaire
The answers to the following questions will assist us in placing your dog in a compatible foster home and finding a suitable, loving adoptive home. Please answer all questions thoroughly and to the best of your knowledge. NOTE: We cannot guarantee that we will be able to take every dog. We must have a compatible foster home and that is determined partly by the information you provide.
Sign in to Google to save your progress. Learn more
Owner name: *
Street address: *
City, state, and zip code *
Phone number: *
Alternate phone:
Email address: *
DOG INFORMATION
Dog's name: *
Dog's gender: *
Dog's age: *
Date of birth, if known:
MM
/
DD
/
YYYY
Where did you obtain the dog? *
How long have you owned the dog? *
Why do you need to surrender the dog? *
HEALTH INFORMATION
Is the dog up to date on vaccinations? *
Please list the name, address, and phone number of the veterinarian who last treated this dog: *
Is the dog spayed/neutered? *
Is the dog microchipped? *
Does the dog have any chronic/ongoing medical conditions or a history of any injury? *
If yes to the above, please explain:
Does the dog have any known allergies? *
If yes to the above, please explain:
Please list any medications the dog is currently taking: *
GENERAL INFORMATION
Is the dog house-trained? *
Does the dog do well with the following? Please check all that apply. *
Required
Does the dog live in a multiple dog household? *
Is the dog crate trained? *
If no to the above, where does the dog stay when left home alone? How does he/she react to that?
Does the dog know any basic commands? *
If yes to the above, please list the commands:
Has the dog had or attended any formal training or obedience classes? *
If yes to the above please list the type of training:
Has the dog ever shown aggression towards people or other animals? *
If yes to the above, please explain:
Has the dog ever reacted poorly to sharing toys/bones/food with humans or other pets? *
If yes to the above, please explain:
Is the dog fearful or intolerant of any of the following? Please check all that apply. *
Required
For any checked responses above, please describe the reaction to each.
Is the dog hand shy or timid? *
Please list any undesirable habits or behaviors we can work on with the dog, such as excessive barking, fence jumping, chewing, leash pulling, separation anxiety, etc: *
If we are able to accept your dog into rescue, what are some things you would like us to know in addition to the above questions? (The more information provided, the easier it will be for us to determine if we can continue to care for your dog as he/she deserves.) *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.