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
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms