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.
Owner name:
Your answer
Address:
Your answer
Phone number:
Your answer
Alternate phone:
Your answer
Email address:
Your answer
Dog information
Dog's name:
Your answer
Dog's gender:
Dog's age:
Your answer
Date of birth, if known:
MM
/
DD
/
YYYY
Where did you obtain the dog?
Your answer
How long have you owned this dog?
Your answer
Why do you need to surrender the dog?
Your answer
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:
Your answer
Is the dog spayed/neutered?
Is the dog microchipped?
Does the dog have any chronic or ongoing medical conditions?
If yes to the above, please explain:
Your answer
Has the dog ever been injured?
If yes to the above, please explain:
Your answer
Does the dog have any known allergies?
If yes to the above, please explain:
Your answer
Please list any medications the dog is currently taking:
Your answer
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?
Your answer
Does the dog know any basic commands?
If yes to the above, please list the commands:
Your answer
Has the dog had or attended any formal training or obedience classes?
If yes to the above, please list the type of training:
Your answer
What is the dog's favorite toy or game?
Your answer
Has the dog ever shown aggression towards people or other animals?
If yes to the above, please explain:
Your answer
Does the dog guard any resources, such as food, toys, bones, beds, people, etc?
If yes to the above, please explain:
Your answer
How does the dog react to being left alone?
Your answer
Is the dog fearful or intolerant to any of the following? Please check all that apply.
Required
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:
Your answer
Please let us know if there is anything else you can share that is special, unusual or endearing about the dog that would help a foster home and new owner:
Your answer
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