Canine Intake Form

The following questionnaire provides us with information about how your dog behaved in many different circumstances while he or she was living with you. Because 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.

Animal's Information
Pet's Name*
Species*
Age*

If exact birthday is known please enter month, day and year otherwise your dogs age.
Sex*
Altered*
Is your pet spayed or neutered.
Is your dog pure breed?*
Breed*

If your pet is not a pure breed please list what he/she is mixed with to the best of your ability.
Color*

How long have you had this pet?*
Is this animal up to date on Vaccinations?*
Veterinary Information
Veterinary Name Clinic Name
What is the reason for surrender?*
Where did this pet come from?*
Has this animal ever bitten someone?*
Has this animal bitten or been bitten in the past 10 days? If so, please explain in detail:*

Feeding History
What brand of dog food do you feed your dog?*
How much food do you feed your dog?*
How often do you feed your dog?

Example: 1 cup at 8am, 2 cups at 6pm, or only feed my dog in the morning.
Does your dog have any food allergies?*
Please list what foods your pet is allergic to.

When playing does your dog ever bite, scratch or exhibit behaviors you would consider rough?*
Please explain:*
Where does your dog like to sleep?*
- On furniture
- Under furniture
- In their bed
- With a person
- Anywhere sunny/warm
- No preference
- Other
If other, please explain*
Are there any wonderful, special traits or habits that you would like his/her new family to know about?
Please upload a current photo of your pet.
Accepted file types: jpg, jpeg, png, gif.
Consent
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