Animal History Form

Woodside Animal Centre is a non selective Dog and Cat Animal Shelter as such, we have limited space due to continual high occupancy.

On occasions where our waiting list exceeds 3 weeks and we cannot take your animal in, we are able to offer appropriate advice.

If your animal is 8 years or over, we will ask that your pet is health checked by a vet. Once this is done, please complete the form.

Answering these questions honestly will not stop the RSPCA from admitting your animal but will ensure that we are able to provide the correct care for your animal.

Please note that Woodside Animal Centre is currently only admitting Cats and Dogs to its facilities.

Animal's Name *
Species *	Badger Bearded Dragon Bird Cat Chicken Chinchilla Cockatiel Degu Dog Dove Ferret Fox Gerbil Goat Goose Guinea Pig Hamster Hedgehog Kestrel Mouse Pig Rabbit Rat Snake Terrapin Tortoise
Gender *	Male Female
Colour *	Amber Apricot Black Black and Brindle Black and Brown Black and Grey Black and Sable Black and Tan Black and White Black, Silver and Tan Black Tortie Blenheim Blond Blue Blue and White Blue and Yellow Blue Merle Blue Roan Blue Tortie Brindle Brindle and Black Brindle and White Brown Brown and Black Brown and White Brown Dapple Chocolate Chocolate Tortie Chocolate, White and Tan Cinnamon Cinnamon Tortoiseshell Cream Cream and Tan Cream and White Fawn Fawn and Black Fawn and White Fawn Merle Fawn Tortoiseshell Ginger Ginger and White Gold and White Golden Golden and White Green Green and Yellow Grey Grey and White Grey and Yellow Grey Dapple Grey Merle Grey Tabby Grey Torti Grizzle and Tan Harlequin Light Amber Lilac Lilac and Tan Lilac Tortie Liver Liver and White Liver Roan Polecat Red Red and White Red Merle Ruby Ruby and White Ruddy Sable Seal Silver Sorrel Sorrel Tortoiseshell Steel and Tan Tabby Tabby and White Tabby/Torti Tan Tan and Black Tan and Brown Tan and White Tortie Tortie and White Tricolour Unknown Various White White and Black White and Brindle White and Brown White and Ginger White and Grey White and Lemon White and Liver White and Tabby White and Tan White and Torti Yellow Yellow and Green Yellow and Grey
Description *
Breed *	Abyssinian Abyssinian Affenpinscher Afghan Hound African Grey Agouti Agouti Agouti Rex Airedale Terrier Akita Akita Inu Alaska Alaskan Malamute Albino Amazon American Bulldog American Bully American Cocker Spaniel Anatolia Karabash Anatolian Shepherd Angora Angora Rabbit Argente Australian Cattle Dog Australian Dingo Australian Kelpie Australian Shepherd Dog Australian Silky Terrier azawakh Balinese Bareback Barn Owl Basenji Basset Griffon Venden Basset Hound Beagle Bearded Collie Bedlington Terrier Belgian Hare Belgian Shepherd Belgian Shepherd Groenende Belgian Shepherd Laekenois Belgian Shepherd Malinois Belgian Shepherd Tervuren Bengal Berkshire Bernese Mountain Dog Beveren Bichon Frise Birman Black Black Black Dominant Spot Black Labrador Retriever Black Rex Black Tan Blazed (Badger) Berkshire Blonde Bloodhound Blue Blue Rex Bombay Border Collie Border Terrier Borzoi Boston Terrier Bourk Bouvier des Flanders Boxer Briard British Blue British Bulldog British Giant British Long Hair British Shorthair British Tipped Brittany Spaniel Budgerigar Buff Bulldog Bullmastiff Bull Terrier Miniature Bull Terrier Standard Burmese Burmilla Cairn Terrier Californian Campbell Albino Campbell Argente Campbell Normal Canaan Dog Canary Cane Corso Cashmere Castor Rex Caucasian Ovcharka Caucasian Shepshed Cavalier King Charles Spaniel Champagne Dargent Chesapeake Bay Retriever Chicken Chihuahua Chihuahua Long Coat Chinchilla Chinchilla Chinchilla Chinchilla Chinese Created Powder Puff Chinese Crested Dog Chinese Crested Hairless Chinese Normal Chinese Spot Chocolate Chocolate Labrador Retriever Chow Chow Cinnamon Cinnamon Cinnamon Pearl Cinnamon Pearl Rex Clumber Spaniel Cockapoo Cockatiel Cockatoo Cockerel Cocker Spaniel Collie Colour Point Continental Conure Corgi Corgi Cardigan Cornish Rex Cream Crossbreed Crossbreed Large Crossbreed Medium Crossbreed Small Crow Curly Coated Retriever Dachshund Dachshund Long Haired Dachshund Miniature Long Hair Dachshund Smooth Haired Dachshund Wire Haired Dalmatian Dalmation Rex Dandi Dinmont Terrier Dark Grey Deer Hound Devon Rex Doberman Doberman Pinscher Dogue de Bordeaux Domestic Domestic Long Hair Domestic Medium Hair Domestic Short Hair Dove Duck Dutch Dutch Long Hair Dutch Shepherd Dwarf Dwarf Eared Dwarf Lop Egyptian Mau Elkhound English English Bulldog English Bull Terrier Cross English Cocker Spaniel English Coonhound English Lop English Pointer English Setter English Shepherd English Spot English Springer Spaniel English Toy Spaniel English Toy Terrier Entlebucher Eskimo Dog Exotic Exotic Shorthair Fawn Rex Ferret Field Spaniel Fila Brasileiro Finch Finnish Lapphund Finnish Spitz Flat-coated Retriever Flemish Flemish Giant Florida White Foreign Blue Foreign Lilac Foreign Short Hair Fox Foxhound Fox Terrier Fox Terrier Smooth Coat Fox Terrier Wire Coat French Bulldog French-Lop Gecko Gerbil German Lop German Pinscher German Shepherd Dog German Shorthaired Pointer German Spitz German Wirehaired Pointer Giant Schnauzer Glen of Imaal Terrier Gloucester Old Spot Gloucestershire Old Spot Golden Golden Dominant Spot Golden Retriever Golden Tort and White Goose Gordon Setter Great Dane Greater Swiss Mountain Dog Great Pyrenees Greyhound Griffon Buxellois Grouse Guinea Pig Hamster Harlequin Harrier Harris Hawk Havana Havana Havana Rex Havanese Hedgehog Hermans Heron Himalayan Himalayan Holland Lop Honey Hooded Horsefield Hotot Hound Hovawart Hungarian Puli Hungarian Vizsla Husky Ibizan Hound Iguana Illyrian Sheepdog Irish Red Setter Irish Setter Irish Terrier Irish Water Spaniel Irish White Setter Irish Wolfhound Isabella Italian Greyhound Italian Spinone Jack Russell Terrier Japanese Chin Japanese Spitz Jersey Wooly Jindo Kai Dog Karelian Bear Dog Keeshond Kelpie Kerry Blue Terrier Kestrel King Charles Spaniel Kishu Komondor Korat Kune Kune Kuvasz Kyi Leo Labrador Retriever Lakeland Terrier Lancashire Heeler Large Black Large White Leonberger Lhasa Apso Lionhead Lizard Lop Eared Lovebird Lowchen Lurcher Lynx Rex Macaw Maine Coon Malamute Malinois Maltese Manchester Terrier Manx Maremma Sheepdog Marten Gable Mastiff McNab Minah Miniature Pinscher Miniature Schnauzer Mini-Lop Mini Rex Mink Mink Mountain Cur Mountain Dog Mouse Munsterlander Neapolitan Mastiff Netherland Dwarf Newfoundland Dog New Guinea Singing Dog New Zealand Norfolk Terrier Norwegian Buhund Norwegian Elkhound Norwegian Forest Cat Nova Scotia Duck-Tolling Retriever Ocicat Old English Sheepdog Orange Rex Oriental Long Hair Oriental Short Hair Otterhound Palomino Papillon Parakeet Parrot Parsons Jack Russell Terrier Patterdale Terrier (Fell Terrier) Peacock Pearl Pekingese Persian Peruvian Inca Orchid Petit Basset Griffon Vendeen Phalene Pharaoh Hound Pigeon Pig (Farm) Pink Eyed Rex Pink Eyed White Plott Hound Pocket Bully Pointer Pointer German Short Haired Pointer German Wire Haired Polecat Polish Polish Lowland Sheepdog Pomeranian Poodle Poodle Miniature Poodle Standard Poodle Toy Portugese Podengo Portuguese Water Dog Pot Bellied Presa Canario Pug Puli Pyrenean Mountain DOg Quail Ragdoll Rat Red Crowned Kakariki Retriever Retriever Curly Coat Rex Rex Rhodesian Ridgeback Ringed Pigeon Roborovski Rosella Rottweiler Russian Blue Russian Toy Dog Sable Sable Banded Sable Roan Saddleback Saluki Samoyed Satin Satin Cream Banded Satin Ivory Satin Lilac Satin Silver Grey Schipperke Scottish Deerhound Scottish Fold Scottish Terrier Scottie Sealyham Terrier Selkirk Rex Setter Shar Pei Sheep Sheep Dog Shepherd Shetland Sheepdog Sheltie Shiba Inu Shih Tzu Siamese Siamese Ab Point Siamese Blue Point Siamese Lilac Point Siamese Red Point Siamese Seal Point Siberian Husky Silky Terrier Silver Silver Fox Silver Marten Singapura Skunk Skye Terrier Sloughi Smooth Fox Terrier Snake Snowshoe Somali South Russian Ovcharka Spaniel Sphynx (hairless cat) Spitz Springer Spaniel Sprocker Staffordshire Bull Terrier Standard Schnauzer St. Bernard Sugar Glider Swan Swedish Vallhund Syrain Tan Terrier Thai Ridgeback Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Tonkinese Tosa Inu Toy Fox Terrier Treeing Walker Coonhound Turkey Turkish Angora Turkish Kangel Turkish Van Turtle Unknown Unknown Unknown Vietnamese Pot Bellied Vizsla Weimaraner Welsh Corgi Welsh Springer Spaniel Welsh Terrier West Highland White Terrier Westie Wheaten Terrier Whippet White German Shepherd Wire-haired Pointing Griffon Wirehaired Terrier XL Bully Yellow Labrador Retriever Yorkshire Terrier
Age *
Owner's reason for parting with animal *
Has the animal lived with children?	Yes No Not known
If yes, please specify the ages of children and animal's behaviour
If no, has the animal had frequent contact with children?	NoYes
If yes, please specify the ages of children and animal's behaviour
Has the animal lived with animals other than cats and dogs? If so, please specify
Is the animal used to men and women?
Has the animal been neutered?	Yes No Unknown
Where did you get the animal from initially? *
How would you describe your animal's behaviour? For example: bold, shy, timid, aggressive, affectionate
How does your animal react to grooming?
How does your animal behave at the vets?
Does your animal have any medical conditions that are undergoing treatment?
Has your animal had any previous operations or treatment for medical conditions?
Does your animal have any known allergies?
Is he/she prone to biting?
Has he/she any unusual behavioural habits?
Have you got vaccination records for the animal?	NoYes
Has the animal ever been destructive in the house? Please describe
Dogs
Has the animal lived with dogs? If so, please specify age, sex and reaction
Has the animal lived with cats? If so, please specify age, sex and reaction
Please describe your animal's feeding regime - brands of food, scraps, dry or tinned, flavours, feeding times and quantities. Any dislikes?
Is the dog housetrained?
Does the animal travel well?
Do you leave the animal alone for any period of time? If so, how long for and do you have concerns about them being on their own?
Is the dog walked on a collar or a harness?
How does the dog react to other dogs outside of the home, e.g. on walks?
Will the animal give up toys when commanded to?
Cats
Has the animal lived with dogs? If so, please specify age, sex and reaction
Has the animal lived with Cats? If so, please specify age, sex and reaction
Please describe your animal's feeding regime - brands of food, scraps, dry or tinned, flavours feeding times, quantities. Any dislikes?
Is the animal litter trained?	NoYes
Does the animal travel well?	NoYes
Does the animal use a scratching post, scratch at furniture, etc?
Person providing information *	Owner Inspector Owner's representative
First Name *
Surname *
First Part of Postcode *
Telephone Number
By Ticking this box, you give consent for the RSPCA Leicestershire Branch to telephone you about the animal only *	NoYes
Email Address
ByTicking this box, you give consent for the RSPCA Leicestershire Branch to email you about the animal only *	NoYes