en-Intake Form

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Intake Form - English

**********IMPORTANT!!!**********

Please provide complete and accurate information about your dog. Incomplete information may result in your form being rejected. We will get in touch with you as soon as we have a opening in our clinic. While you wait for us to contact you, please click here to read this page for important information about our program.

All fields with an * are required. If you don't know the answer to a question, select the "unknown" option.

Your contact information:

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We need a way to contact you so please make sure your contact details are accurate. Double check your entries PLEASE!!

If the dog is fostered someplace other than your home, you ultimately are responsible for insuring it is fed, watered, taken to the vet, socialized and prepared for adoption. Our volunteers will also need access to the dog for photos, assessments, and helping you get the dog adopted.

Basic information about the dog:

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What breed or breeds best describe your dog? Select as many as apply and avoid of a single description of "mixed."

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History about the dog:

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Dog's foster environment:

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Including yourself, how many people of the following ages live in the house with the dog? Please fill in the boxes.

Age range (years)FemaleMale
0-3
4-9
10-17
18-29
30-59
60+

How long is the dog left alone, without people, each day? Select one that best applies.

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Where does the dog usually sleep overnight? Select the one that best applies:

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Where does the dog spend most of his/her time?

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What is the dog's energy level in the home?

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Is the dog energetic outdoors but have relaxed energy in the home?

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Dog's behavior:

Please be honest in your answers below. We want to find the right home for this dog and that means a family accepting of its behaviors - good and bad:

How does the dog respond to children?

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How does the dog respond to smaller animals such as cats?

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Is the dog sociable with other dogs?

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Does the dog usually uncontrollably chase or attempt to chase any of the following? Please select all that apply

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When left alone, does the dog usually show any of the following behaviors? Check all that apply:

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How does the dog respond to unfamiliar people you invite into the home? Please select all that apply below:

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How does the dog usually react when a stranger approaches or enters the yard or home? Please select one:

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Does the dog have aggressive behavior over any of these items? Please check all that apply.

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Has the dog ever shown any aggressive behaviors toward men, women, children, dog, or animal species such as cats? Please Explain.

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Training:

Please describe any training the dog has mastered here.

Extent to which the dog is housebroken:

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Does the dog have "accidents" in the house?

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Do you take the dog outside to go to the bathroom?

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Crate training:

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Leash training:

Have you ever walked the dog on a leash?

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If you have walked the dog on a leash, how does he or she do?

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How is the dog in a car?

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Personality:

Be as descriptive as possible. If you say the dog plays, how does it play (fetch, with other dogs, chase its tail). If it is friendly, give examples (it likes to cuddle in your lap, lick your face). Describe unique things about the dog that you think make it adoptable.

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Ideal home for the dog:

Consider the kind of home where the dog will thrive - not necessarily a replication of its foster home.

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Is the dog suitable for a home with children?

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Is the dog suitable for a home with cats or other small animals?

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Is the dog suitable for a home with other dogs?

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Dog food program:

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Thank you for saving this dog and for taking the time to provide us the most complete and accurate information possible! We want to find a home where this dog will not only be safe, but will thrive! Together we can do it!