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Surrender Questionnaire
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What is your name?
Your answer
Please provide us an email where you can be reached.
Your answer
Please provide us a phone number where you can be reached.
Your answer
Where does the dog currently live? State/Province, and City.
Your answer
What is your relationship to the dog?
Owner
Co-owner
Breeder
Shelter or rescue
Clear selection
Why do you need to re-home the dog?
Your answer
If you are the dog's owner or co-owner, did you get them from a breeder?
Yes
No
Clear selection
If "yes", which breeder?
Your answer
What is the dog's name?
Your answer
What is the dog's birth date? (Estimate if you do not know for certain.)
MM
/
DD
/
YYYY
What is the dog's sex?
Male
Female
Clear selection
Has the dog been spayed/neutered?
Yes
No
Clear selection
Please describe the health of the dog? Are there any issues? Are they on medication?
Your answer
How is the dog with children?
Your answer
How is the dog with strangers?
Your answer
How is the dog with other dogs?
Your answer
How is the dog with other animals?
Your answer
Has the dog had any training?
Your answer
Has the dog ever bitten anyone? What were the circumstances?
Your answer
Has the dog ever bitten another animal? What were the circumstances?
Your answer
Has the dog ever lived with someone else?
Your answer
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