Surrender Questionnaire

Owner's Contact Information *
Owner's Contact Information
Address *
Phone *
Spayed/Neutered *
Vaccinated *
Has the dog been de-wormed? *
Phone Number of Veterinarian *
Phone Number of Veterinarian
Has this dog ever been to a groomer? *
Has this dog ever acted aggressively towards or bitten: *
Has this dog lived with other dogs or other animals in the same household?
How does this dog respond when approached by new people?
Has this dog had any incidents of urinating/defecating inside of the home?
How would you rate this dog’s recall?
Has this dog been fed table scraps or any kind of human food?
Has this dog been known to take food off of a counter top or got into the garbage?
Has this dog been known to eat unusual items other than food?
Has this dog been known to chew items other than their own toys? (ie. furniture, footwear etc)
Has this dog been known to bark excessively?
Has this dog ever taken any obedience classes?