The following questionnaire provides us with information about how your dog behaved in many different circumstances while he or she was living with you. Since your dog is likely to behave in similar ways in his new home, this information will help us find the most suitable home for your dog and to effectively counsel the new family. Your open and honest answers are very necessary and appreciated, so that we can do careful and successful adoptions.
First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Cell Phone*
What is the name of your pet?*
Why are you wishing to surrender this animal?*
What Species and Breed is your pet? How much does your pet weigh? *
What is this pet's gender? Is this pet spayed or neutered?*
How old is your pet?*
Where did you get this pet from and how long have you had this pet?*
Is this animal housebroken?* Choose one: Yes No Unknown
What other animals did this animal live with? Please indication which animals the animal got along with, and which animals the animal did not get along with.*
Which of the following does this animal chase? Joggers, Bicycles, SkateBoarders/Rollerbladers, Cars/Motorcycles, Indoor cats, Outdoor cats, Squirrels or other small animals, Birds*
Including yourself, how many people live in your house? Please list their genders and age and if this pet gets along with them. *
Describe the socialization level of this animal with other animals and children (i.e. does this dog go to the dog park and have tons of friends or prefer to be an only dog? Does this dog say hi to their neighborhood kids on walks?)*
Where does this animal sleep at night?*
Where does this pet spend most of his/her time when you are home?
Where does this pet spend most of his/her time when you are NOT home?
How much time does this animal spend alone, without people? *
How does this animal usually react to strangers?*
How does this animal react to strange dogs that they have not met before?*
Please describe the obedience and training level of this animal*
Please tell us about your animals "bad habits"*
Please describe, in detail, any instances when your dog has nipped or bitten another animal or human. Please include the dates or approximate dates of any/all instances.*
Is your dog currently on any medication or special diet?*
Does your dog have any past or present medical conditions?*
Are you willing to make a donation towards this animals care?*
Please feel free to provide any additional helpful comments*