Northern California Weimaraner Rescue Dog Intake Screening Form

Northern California Weimaraner Rescue Dog Intake Screening Form
OWNER SURRENDER DOG INFO

Please be sure to answer the following questions honestly. This will help us find the best home for your dog.
Owner Information
Owner's Full Name:*
Owner's Street Address:*
Owner's City, State, Zip*
Owner's Cell Phone:*

Area Code Phone Number
Owner's E-mail:*
Basic Dog Information
What is the Dog's Name*
Male or Female*

MaleFemale
Dog's Color (grey or blue)?*
Is your dog a purebred or a Weimaraner mix? If a mix, what is the secondary breed?*
What is the dog's birthdate and age? (Actual or approximate?)*
What is the dog's weight?*
Is the dog's tail docked?*

YesNo
Have the dog's dew claws been removed*

YesNo
Why do you need to rehome your dog?*
Where did you get your dog? If from a breeder, what is the name of the breeder?*
How long have you had your dog?*
Are you the dog's legal owner?*
Does your dog have a microchip*
Health Information
Is your dog spayed or neutered?*

YesNo
Are your dog's vaccines up to date? Do you have the vaccine records?*
Does your dog have any medical issues (i.e. heart, kidney, liver, joints)?*
Does your dog have any injuries (old or new)? Please describe.*
Does your dog take any medications or supplements? Please describe.*
When was your dog last seen by a Veterinarian? *
How does your dog do at the vet (i.e. super stressed or needing to be muzzled)?*
Who is your dog's Veterinarian?*
Will you give us permission to speak with the Veterinarian?*
What type of food does your dog eat?*
Behavior and Temperament
Has your dog ever bitten anyone? What were the circumstances?*
Does your dog have separation anxiety (destructiveness or barking when left alone)?*
How long is your dog used to being left home (with or without other dogs)? *
What is your dog’s exercise routine?*
Does your dog have any obedience training/skills?*
How is your dog on leash (i.e. pulls a little, a lot, easy to walk)?*
Is your dog house trained?*
Is your dog crate trained? If so, when does your dog go into the crate?*
How does your dog ride in the car (i.e. rides a crate, tethered, just goes to sleep on the seat)?*
Personality
Is there anything your dog does not like/enjoy or causes him/her stress (i.e. loud noises)?*
Are there any ways your dog does not like to be touched?*
Is your dog possessive with food or toys (i.e. growls or snaps when people or dogs approach their food or toys?) Please explain: *
Personality/Interactions with People
What does your dog enjoy doing (i.e. playing with toys, chasing a ball, hiking, etc.)? *
Are there any behaviors we should know for placement (i.e. jumping on people, excessive barking, etc.)? *
Has your dog lived with children? If so, what ages?*
Interactions with Other Animals
How is your dog with other dogs (i.e. large dogs, small dogs, males or females)?*
Does your dog go to the dog park?*
Does your dog have experience living with cats indoors?*
Has your dog ever been in a fight with another dog? If so, what were the circumstances?*
Additional Information
Please upload a few photos of your dog and copies of any vaccine/records you have.

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Is it ok for a NCWR volunteer to visit for a brief temperament evaluation and/or get additional photos?*
We may have foster homes available. If so, how soon do you need the dog to go to foster? *
Would you be willing to help transport your dog part way to the foster home?*
Please provide days of the week/times you would be available for a phone call to discuss your dog’s needs.*
Please note our incoming call to you may appear as "Caller ID Blocked" or have a number you do not recognize. Please answer unknown incoming calls on the days you list above.
Is there anything not listed in this screening form you would like us to know?*
Should be Empty:

Northern California Weimaraner Rescue Dog Intake Screening Form

Owner Information

Basic Dog Information

Health Information

Behavior and Temperament

Personality

Personality/Interactions with People

Interactions with Other Animals

Additional Information