Intake Form Intake Form Name* First Last Phone*Email* Dogs Name*Legal Owners*Breed*Purebred*YesNoPapers*YesNoGender*MaleFemaleSpayed/Neutered?*YesNoColor*Age*Weight*History (how long owned and where from ?)*Temperament: (With kids? Ages of kids he's been around? With Dogs? With Cats?) Any aggression of any kind with anything?(growling, snapping, biting?) Can you take food away and feed with other animals? Toys? Bones? Accept strangers? Sensitive to touch? Dislike or afraid of anything?*Why surrendering?*Health issues? If so, please describe:*Vaccines? Vet name?*Is dog currently on heartworm prevention?*YesNoBad habits?*Housebroken?*YesNoObedience trained?*YesNoHave you or anyone in your household had symptoms of Covid 19 such as shortness of breath, fever, or cough or have you or anyone in your household been exposed to anyone who has symptoms of Covid 19?*YesNoHave you or anyone in your household traveled outside the United States in the last 14 days?*YesNoPlease send us a picture of the dog:*CAPTCHACommentsThis field is for validation purposes and should be left unchanged.