DOG PROFILE SURRENDER QUESTIONNAIRE

Date *

Dog and Owner Information

Dog's Name *

Dog's Approximate Age *

Birth Year *

Breed *

Colouring *

Sex *

Is your dog Desexed *

Is your dog microchipped? *

Microchip Number:

Who is it regsitered to? *

Does your Dog have a tattoo? *

If Yes where is it located? *

How Long has your dog lived with you? *

Owner name *

Owner Surname *

Address *

City *

Postcode *

Mobile Number *

Alternate phone number

Email: *

Surrender Information

Why are you surrendering or returning this dog? *

If the reason is behaviour, expalin the behaviour and the actions you have taken to solve it. *

If we could help resolve the issue, would you be interested in keeping the dog? *

Where did you get this dog? *

Name of Shelter or Rescue *

If you got the dog from a breeder, what is the name and location of the breeder? *

Have you attempted to return the dog from where you obtrained it? *

If yes, what was the reason they did not take it back? *

Have you contacted any other rescue groups that might help rehome your dog? *

If Yes, what was the reason they were not able to help you? *

Your Dog's Lifestyle

How many hours a day is your dog left alone? *

How many days per week? *

Does your dog tolerate this well? *

If no, why not? *

How many hours a day does the dog interact with people on a daily basis? *

If it varies please explain *

Where does your dog stay when you are not home? *

If other please explain *

Where does your dog spend his/her time when you are at home? *

If Other please explain *

Explain how your dog is confined to your property when outside (check all that apply) *

Electronic Pet Containment System (what type) *

If Other please explain *

Type of fencing? *

How high is the fence? *

Can your dog be left outside unsupervised? *

If no, why not? *

Where does the dog sleep at night? (check all that apply) *

If Other please explain *

Is the dog housetrained? *

If not house trained, check all that apply *

Do your dog’s housetraining accidents most happen when: (check all that apply) *

If Other please explain *

How have you addressed this problem? (check all that apply) *

If Other pelase explain *

Is the dog crate trained? *

How long was dog in the crate each day? *

Have you ever boarded your dog while away? *

Type of service: (check all that apply) *

How did your dog react to you being away? *

Is your dog permitted to be on furniture? *

Does the dog jump up on people when greeting them? *

Is the dog constantly underfoot when food is present? *

Does the dog beg at the table or in the kitchen? *

If yes, is the behavior rewarded with food? *

Behaviour and Training

What training/activities did you participate in with your dog? (check all that apply) *

Please tell us about the tricks and habits you have taught your dog: (check all that apply) *

If Other please explain *

What words does the dog understand? (check all that apply) *

If other pelase explain *

Does your dog run after cars, bikes, or pedestrians? *

If yes, what does the dog do when he/she gets to them? *

Describe the dog’s behavior in the car: (check all that apply) *

If other please explain *

When in vehicle, is dog *

Is the dog destructive if left alone inside the home? *

If yes, please check all that apply *

If other please explain *

Does the dog raid the kitchen bin? *

Will the dog steal unattended food/objects from tables/counters? *

If yes, how have you addressed the problem? *

How does your dog walk on a leash? *

If Depends on situation please explain *

Is the dog protective or possessive of any of the following? (Check all that apply)

If Other please explain

Please check all of the following that frighten your dog or makes your dog scared or reactive *

If Other please explain *

Interaction with other animals

Describe the dog’s behavior around other dogs: (check all that apply) *

If Other please explain *

Would you recommend placing this dog in a home with other dogs? *

If no/maybe, please explain why *

Describe the dog’s behavior around cats: (check all that apply) *

If Other pelase explain *

Would you recommend placing this dog in a home with cats? *

If no/maybe pelase explain why *

If your dog has been around livestock, what was his/her reaction? (check all that apply) *

Types of Livestock *

Has dog bit/killed livestock *

If yes pelase explain *

Would you recommend placing the dog in a home with livestock? *

If no/maybe please explain why *

Additional comments on how your dog is with other animals *

Children and Family

Has your dog lived with children? *

What ages of children has your dog lived with? (check all that apply) *

Did your home have children as visitors regularly? *

If yes, what were the ages of the children? *

Will the dog allow handling by children younger than 6 years old (having ears lifted/tugged, tail held/grabbed, fur scrunched/grabbed)? *

Has a child ever tripped over, stepped on, or fallen on your dog? *

If Yes, what was the dog's reaction? *

How does your dog react to a child approaching when he/she is sleeping? *

Is your dog possessive over where he/she sleeps? *

If yes, what does he/she do? *

Would you recommend this dog live with children? *

Why or why not? *

Would you recommend this dog live where children visit on a regular basis? *

Describe your dog’s behavior around children: (check all that apply) *

If Other please expalin *

Will the dog allow a child to touch its food without reacting? *

Does the dog try to take food from children when it is not offered? *

Will the dog gently take treats offered by a child? *

Does the dog hover nearby when the child has food? *

Has a child ever fed/watered your dog? *

Does your dog allow children to brush/hug/pet it? *

Describe Dog's reaction to a child running *

Describe Dog's reaction to a child falling down *

Describe Dog's reaction to a child jumping, hopping, etc *

Describe Dog's reaction to a child yelling or screaming *

Describe Dog's reaction to a child swimming *

Describe your Dog's reaction to a child waving arms or other unexpected movements *

Health, Grooming and Diet

Did this dog see a veterinarian on a regular basis (at least once a year)? *

Veterinarian/Clinic name: *

Is the dog current on vaccinations? *

If no, which ones are due? *

How does the dog react at the vet? *

Does the dog need to be muzzled at the vet? *

Does your dog require any medication on a regular basis? *

If yes, what kind and for what condition? *

Does the dog allow you to clip his/her nails? *

Does the dog like to be brushed? *

Are there places that he/she does not like being brushed or petted?

If yes, where? *

Has your dog ever been professionally groomed? *

If yes, how did the dog behave? *

Has your dog ever been hit by a car?

If yes, please explain when, what happened and type of injuries?

Has this dog ever been diagnosed/treated for any of the following: (check all that apply)

Please outline Other illness/condition

What brand of food does your dog eat? *

How much and how often? *

Would you consider your dog to be a picky eater? *

If yes, please explain *

Does your dog have any allergies/sensitivities to any grains or ingredients? *

If yes, to what and what symptoms? *

Is your dog on any flea treatment? *

What Brand of flea treatment *

Other Flea Brand *

Exercise and Play

What are the dog’s favorite kinds of toys? (check all that apply) *

Other toy *

What does your dog do with his/her toys? (check all that apply) *

Describe other behavior *

What type of exercise does the dog receive on a regular basis (several times a week)? *

Describer other exercise *

Describe your dog’s play style with people: (check all that apply) *

Describe Dogs other play style *

Describe your dog’s play style with other dogs: (check all that apply) *

Describe other play behaviour with dogs *