X - PPTF Surrender Assessment Form (no longer used)

Basic information

Your name *

Dog's name *

Is the dog neutered/spayed? *

Yes
No

When was the dog's last season (if applicable), and are you willing to get the dog neutered? *

Is the dog fully vaccinated? *

Yes
No

When was the dog vaccinated (approx.)? *

Are you willing to get the dog vaccinated? *

Is the dog microchipped? *

Yes
No
Don't know

What is the dog's microchip number? (If you do not know, please say "Unsure")

Is the dog currently on any medication? *

Yes
No

Please list any current medications or supplements: *

What was the date of the dog's last vet visit? *

What was the date of the dog's last vet visit?

Unsure

What was the date the dog was last flea and wormed? *

What was the date the dog was last flea and wormed?

Unsure

Behaviour and temperament

How is the dog with people visiting the home? *

Has the dog ever bitten or growled at anyone? *

Yes
No

Please provide details: *

Has the dog ever shown any resource or food guarding issues? *

Yes
No

Please provide details: *

Does the dog accept a collar, harness, and/or lead? *

How does the dog behave while on a lead? *

How is the dog on walks with other people, dogs, children, or other stimuli? *

Has the dog been around or lived with children? *

Yes
No

What age(s) were the children, and how did the dog behave around children? *

Has the dog been around or lived with other dogs? *

Yes
No

How was the dog around other dogs? *

Could the dog share their home with another dog? *

Yes
No

Has the dog ever growled or bitten another dog? *

Yes
No

Please provide details: *

Has the dog ever been around cats? *

Yes
No

How is the dog around cats? *

Has the dog ever shown any prey drive? *

Is the dog toilet trained? *

Yes
No

Is the dog crate trained? *

Yes
No

Has the dog ever been destructive? *

Yes
No

Please provide details - what did they destroy? What were the circumsances? *

Can the dog be left alone? *

Yes
No

How long has the dog been left alone for previously, and how did they cope with this? *

How is the dog overnight? *

Does the dog travel well in the car? *

Are you able to provide help with transporting your dog to their new home? *

Yes
No

How far would you be willing to transport your dog? *

Please tell us any of your dog's likes or dislikes, or anything personal to add to their profiles. *