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Brunswick, GA
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Dog Intake Questionnaire
Pet Adoption
Dog Intake Questionnaire
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Stray
Owner Surrender
How many dogs/puppies are you surrendering?
*
Dog's Name and Gender (If more than one, please list all.)
Approximate Age:
Breed:
Please select all that apply:
Spayed/Neutered
Microchipped
Reason for surrender? (Please explain.)
*
How long have you been caring for this dog?
*
Where did you acquire this dog?
*
Has this dog been seen by a veterinarian?
Yes
No
Veterinarian's Name:
Please list and explain any health issues we need to be aware of:
House trained?
Yes
No
Somewhat, still learning.
Crate trained?
Yes
No
No longer needs a crate.
Where does this dog primarily live?
Indoors
Outdoors (fenced in yard)
Outdoors (tied out)
If kept outdoors, how many hours per day?
Can this dog be left alone in the house without problems? (Please explain.)
Please describe any destructive tendencies or separation anxiety:
Please select all that apply:
*
Good with children
Good with men
Good with women
Unknown (stray)
Please select all that apply:
*
Good with other dogs
Not good with other dogs
Somewhat good with other dogs, can be selective
Good with cats or other small animals
Unknown (stray)
Are you able to safely remove food, toys, or other items?
Yes
No
Sometimes, depending on the item
Activity Level:
Very high (needs lot of exercise)
High
Medium (happy with a short walk)
Low
Please list any commands your dog(s) know:
Please select all that apply:
Barks when left alone
Allowed on furniture
Crated when alone
Accustomed to eating dry food
Accustomed to eating canned food
Has your dog ever bitten anyone?
*
Yes, provoked
Yes, unprovoked
No
Unknown (stray)
Has your dog ever growled at anyone?
*
Yes
No
Unknown (stray)
Has your dog ever snapped at anyone?
*
Yes, provoked
Yes, unprovoked
No
Unknown (stray)
If you answered yes to any of the above questions, please explain.
What else would you like for us to know about this dog?
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