Intake Form

Name*

First Last

Phone*

Email*

Dogs Name*

Legal Owners*

Breed*

Purebred*

Yes
No

Papers*

Yes
No

Gender*

Male
Female

Spayed/Neutered?*

Yes
No

Color*

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?*

Yes
No

Bad habits?*

Housebroken?*

Yes
No

Obedience trained?*

Yes
No

Have 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?*

Yes
No

Have you or anyone in your household traveled outside the United States in the last 14 days?*

Yes
No

Please send us a picture of the dog:*

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