Incoming Dog Profile
Please be honest while filling out this form so we can find the best outcome for your dog.
Part 1: Name of dog
Male or female
*
Your email address:
*
Phone number:
*
Dog's name:
*
What gender is your dog?
*
Male
I don't know
Dog's age:
Does your dog have a microchip?
Yes
No
I don't know
How long have you had your dog?
What is your reason for surrender?
*
What would need to happen in order for you to keep your dog?
*
Where did you get your dog?
*
Please Select
FWACC
Other Shelter
Friend/relative
Gift
Own Litter
Craigslist
Found Stray
Breeder
Pet Store
Other
Describe your household.
Please Select
Quiet
Active
Noisy
Are there other animals in the home?
*
Yes
No
What types of animals has your dog been around?
Cats
Dogs
Other
How many other dogs has your dog been around?
How many cats has your dog been around?
Has your dog been around children?
Yes
No
I don't know
What ages are the children your dog has been around? (check all that apply)
0-1 year old
1-6 years old
6-15 years old
15 years and older
Would you recommend putting your dog in a home with other dogs?
Yes
No
I don't know
How does your dog act or behave around the following. Check all that apply.
Friendly
Cautious
Fearful
Submissive
Tolerates
Aggressive
I don't know
Children
Strangers
Other Cats
Dogs
What other information should we know about your dog's interactions with animals and people?
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Part 2: Medical History
Does your dog see a veterinarian on a regular basis?
Yes
No
What veterinarian office does your dog go to?
Does your dog have any present or past medical conditions?
Yes
No
What medical conditions does your dog have?
Is your dog currently on any medications or special diets?
Yes
No
Please list medications or special diet.
Is your dog spayed or neutered? (Did your dog have an operation so it can't have babies?)
Yes
No
I don't know
What type of food does your dog eat? (Check all that apply)
Dry
Wet
Both
What brand of dog food does your dog eat?
Part 4: Behavior
Check all that describe your dog's personality (Check all that apply):
Playful
Couch potato
Lap dog
Affectionate
Destructive
Shy
Aggressive
Independent
Talkative
Friendly with visitors
Shy with visitors
Uses mouth/jumps up in play
What does your dog destroy?
Doorways
Shoes and other personal items
Their toys
Furniture
What words does your dog understand (check all that apply):
Sit
Stay
Down
Come
Leave it
Drop
Wait
Heel
Off
Other
Please check all that frighten your dog:
Babies or toddlers
Teenagers
Women
Men
People in uniform
Loud voices/yelling
Sudden movements
Unpredictable children
School-aged children
Men
Strangers/visitors
Veterinarian/groomer
Fireworks/loud noises
Water
Car rides
What does it look like when your dog is frightened?
Are there any places on your dog's body he/she does not like to be touched, brushed or petted?
Yes
No
Please list the places they do not like being touched:
Has your dog ever bitten?
Yes
No
Please describe the time your dog has bitten in as much detail as possible.
Did the bite break skin?
Yes
No
Has your dog ever snapped at a person or other animal?
Yes
No
Please check all that apply to the time or times your dog has snapped:
at a child
at an adult
at another dog
at a cat
Other
Has your dog ever nipped at someone or another animal?
Yes
No
Please check all that apply to the time or times your dog has nipped:
at a child
at an adult
at another dog
at a cat
Other
Where does your dog live?
Indoor only
Outdoor only
Indoor/Outdoor
Other
How does your dog play with other dogs?
Will play with other dogs
Picky about the dogs they like
Plays rough with other dogs
Does not enjoy playing with other dogs
Hangs out with other dogs rather than plays
Chases or herds other dogs
Prefers dogs that are gentle or indifferent
Barks constantly
What is your dog's favorite thing to do?
How does your dog do on leashed walks?
Great
Pulls a little
Pulls very hard
Doesn't go on leashed walks
Can your dog be left alone in the house for 8 hours a day without issues?
Yes
No
Where does the dog stay when no human members of your family are home?
Free roam of the house
Confined in a particular room
In garage or basement
Crated
Outside
Does your dog escape the yard?
Yes
No
Housetraining:
No accidents
Pees inside the house
Poops inside the house
Is this dog possessive or protective?
Yes
No
What is your dog possessive or protective of?
people
food
toys
other dogs
What does it look like when your dog is being possessive or protective?
What is your dog's best quality?
What is your dog's worst quality?
Please list any other information it's important for us to know about your dog!
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