Dog Intake Form

To help us get back to you as quickly as possible with a decision, please provide detailed, honest and accurate information.
Things to know: You’ll be asked to share details of medical history, behaviour, and photos of your dog. If you're looking to rehome more than 1 dog then you will be required to fill out the form for each individual dog. It takes around 10-20 minutes to complete an application for each dog. If you're happy with the above then please continue.
Title *
First Name: *
Last Name: *
Address: *
Town: *
County: *
Postcode: *
Mobile Number: *
Email Address: *
Can we keep in touch? We'd love to send you updates about what’s happening at CDCH, including heart-warming pet stories, expert pet advice, and how you can support our vital work. Simply let us know how you’d like to hear from us: *	Contact me via phone Contact me via email Contact me via both I opt out of keeping in touch
Where did you hear about us? *
We appreciate a minimum donation of £50 towards each dog we rehome. Can you give a donation? *	Yes, I can give £50 for each pet I can make a small donation I am unable to make a donation at this time
What is the main reason for parting with your pet? *
Are you the registered keeper on the microchip of this pet(s)? *
If you have stated no, you will be required to fill out the owner's details below:
Owners Name:
Owners Address:
Town:
County:
Postcode:
Owner's Number:
Owner's Email:
If we can help you keep your pet, would you be interested in discussing the options? *
If offered an appointment at CDCH, do you have transport to be able to attend the centre? *
*	Euthanasia Policy* We will never put an animal to sleep to make space for another animal to come into us. Pets who's emotional and physical needs cannot be safeguarded will be assessed, reviewed and necessary steps implemented to improve this. If a pet is found to have an untreatable or serious medical problem(s), or behavioural issues so severe we deem them unsafe to be rehomed, then euthanasia will be considered. Tick the box to say "I understand and agree with your euthanasia policy."
Rehoming more than one pet: If you're looking to rehome more than 1 dog at this time then you will need to complete an individual form for each dog. If you're looking to rehome more than 1 species you will be required to fill out the relevant species form for each animal.
Tell us about your pet:
Dogs Name: *
Did you rehome this dog from CDCH? *
What breed is your dog? *
What age is your dog? *
What colour is your dog? *
What sex is your dog? *
Neuter status of the dog? *
How long have you owned the dog? *
Where did the dog orginally come from? *
If rescued, has the previous centre been contacted?	Yes No
Is the dog microchipped? *
Has this dog ever been seen by a vet? If yes, please name and address the vet practise they're registered with. *
Was your dog born or purchased from outside the uk? If yes, tell us what country and history they came from? *
If your dog was born or purchased outside of the UK, have they had a negative test for Brucella Canis?
We will now ask you some more questions on your dogs medical and behaviour history. Please answer these questions to the best of your ability and honestly so we can ensure the best help for you and your dog.
Does your dog have a current medical condition, or had one in the past? *
If you have stated that your dog has a medical condition or has previously had one, please provide us with more details of the condition below (e.g. when were they diagnosed, what is the condition called or related to etc?
Is your dog comfortable with both male and females? *
If NO, please state why;
Information on current home life * Use the text box below to describe what your dogs current homelife is like. Please provide details of; How many people live in the household? Is it a quiet household or a busy one? Do they live with children? If so, how old? Do they live with other dogs? Do they live with cats or other animals? What sort of area do you live in e.g. rural, urban etc?
What is your dogs behaviour like towards adults they're familiar with? *
What is your dogs behaviour like towards visitors in the home? *
What is your dogs behaviour like towards children? *
What is your dogs behaviour like towards dogs outside the home? *
What is your dogs behaviour like when they're left alone? *
How long is your dog left alone for on a regular basis? *
Has your dog ever lived with another dog? *
If yes, detail the dog (e.g. age, breed, sex) and how they behave around each other?
Has your dog ever bitten anyone?
Has your dog ever bitten anyone? *
If yes, what damage was caused?
It's important for us to have as much information as possible about a bite incident so we can try and understand why this behaviour occurred. If you can, please provide us with who was involved, where it happened and what was happening just before, during and after the event;
Has your dog snapped at a person but not made contact? *
If yes, how often has your dog displayed this behaviour?
Has your dog ever barked or lunged at people? *
If yes, please describe what situation this occurred in;
Has your dog ever bared it's teeth at people? *
If yes, please described the situation this occurred in;
Does your dog ever growl or actively avoid people? *
If yes, please describe the situation it occurred in;
Does your dog frequently display any of the following behaviours obsessively? This behaviour(s) would happen more than a few times per day to be considered frequently and the behaviour can be very difficult to stop.
Does your dog frequently display any of the following behaviours obsessively? *	Tail Chasing Light Chasing Shadow Chasing Spinning Biting Itself Consuming inappropriate or inedible items Licking Walls No
Tell us what motivates your dog? *
Tell us more about your dogs personality and/or behaviours... *
Upload a good quality photo of your dog! *

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