My Dog's Bark

Your name* This field is required.This information will not be made public

First Name

Last Name

Your email* This field is required.This information will not be made public

example@example.com

Dog's Name* This field is required.

DOB/Age:* This field is required.Approximate is okay

Sex* This field is required.

Female

Male

Is this dog spayed/neutered?* This field is required.

Yes

Unknown

Breed(s) (or best guess)* This field is required.

Reason for Surrender* This field is required.Please be as specific as possible

When you are home, where is the dog?* This field is required.

Inside

Outside

Free access inside and outside

When you are away, where is the dog?* This field is required.

Inside

Outside

Free access to inside and outside

Has this dog ever escaped the house/yard?* This field is required.

Yes

Please explain how this dog has escaped the house/yard* This field is required.

Is this dog crate-trained?* This field is required.

YESNO

When is the dog in a crate, and for how long?* This field is required.

Where does this dog sleep?* This field is required.

Inside

Outside

Where inside does this dog sleep? On what? With whom?* This field is required.

Where outside does this dog sleep? On what? With whom?* This field is required.

Is this dog housetrained?* This field is required.

Yes

A work in progress

Please explain this dog's potty habits* This field is required.

Where does this dog go potty?* This field is required.

Newspaper

Pads/similar product

Littler box

Walks

Yard

Through dog door

Let out by person

Other access

Other access* This field is required.Please describe

How do you know when this dog needs to go potty?* This field is required.

Goes to the door

Barks

Paces

Uses dog door

On a set schedule

Other

You selected 'other'* This field is required.How do you know when this dog needs to go potty?

Does this dog like to be picked up?* This field is required.

Don't know

Yes

What areas of your dog's body do they NOT like to be touched/handled?* This field is required.

How does your dog behave during visits to the vet?* This field is required.

Are you able to clip the nails?* This field is required.

Never tried

Yes- by myself

Yes- with a helper

Does this dog get exercise?* This field is required.

YESNO

What kind of exercise, how long, and how frequent?* This field is required.

Between 0 and 5, where does this dog's play style fall?* This field is required.

0 (gentle)

5 (Rough & Tumble)

What toys does this dog like?* This field is required.

What activities did you do with this dog that the dog enjoyed?* This field is required.

Petting

Brushing

Playing fetch

Playing tug

Playing chase

Rough

Running errands

Training games

Training classes

Road Trips

Quiet companionship

Other

You selected 'other'* This field is required.Please list what other activities this dog has enjoyed

What type of food does this dog eat?* This field is required.

Canned dog food

Dry dog food

Dry mixed with canned

Special diet

You selected 'special diet'* This field is required.Please explain

How often/how much does this dog eat?* This field is required.

Once daily

Twice daily

Free fed

Does this dog have any favorite treats?* This field is required.

Was this dog exposed to your other dog(s) in the house?* This field is required.

No other dog(s) in the house

Yes

You selected 'yes'* This field is required.What is the sex/size of your other dogs?

How did this dog and your other dogs in the house interact?* This field is required.

Very affectionate

Playful and energetic

Peacefully coexisted

Slept near one another

Ignored eachother

Fought w/out injuries

Fought w/ injuries

Caused this dog stress

Was picked on by other dog

Picked on other dog

Growled/bared teeth

Played too rough

Other

You selected 'other'* This field is required.Describe how this dog and your other dog(s) interacted

Was this dog exposed to your cat(s) in the house?* This field is required.

No cat(s) in the house

Yes

You selected 'yes'* This field is required.How many cats to you have in the house?

How did this dog and your cat(s) in the house interact?* This field is required.

Played together

Avoided eachother

Peacefully coexisted

Dog feared cat

Cat tormented dog

Dog tormented cat

Dog chased cat

Dog growled/bared teeth

Fought w/out injuries

Fought w/ injuries

Other

You selected 'other'* This field is required.Describe how this dog and your cat(s) interacted

Was this dog exposed to other dogs OUTSIDE of the home?* This field is required.

YESNO

What was your dog's reaction?* This field is required.

Friendly

Playful

Tolerant

Afraid

Aggressive

You selected 'aggressive'Please explain your dog's behavior when exposed to other dogs OUTSIDE the home

Was this dog exposed to other species?* This field is required.

YESNO

Yes, what other species?* This field is required.

What was your dog's reaction?* This field is required.

Friendly

Playful

Tolerant

Afraid

Aggressive

You selected 'aggressive'Please explain your dog's behavior when exposed to other dogs OUTSIDE the home

Which commands are this dog familiar with?* This field is required.

Sit

Down

Stay

Wait

Come

Speak

Shake

Fetch

Roll over

Other

You selected 'other'* This field is required.Please list what other commands your dog is familiar with

What leash walking behavior is this dog familiar with?* This field is required.

Heel

Walks on a loose leash

Walks on a tight leash

Pulls on leash

Struggles and bites leash

No exposure to a leash

Other

You selected 'other'* This field is required.Please list what other leash walking behavior your dog is familiar with

How hard does this dog pull on a leash?* This field is required.

0 (does not pull)

7 (drags you)

What training equipment has this dog been exposed to?* This field is required.

Clicker

Treats

Head halter

Harness

Choke chain

Prong/pinch collar

Electronic collar

Other

You selected 'other'* This field is required.What other training equipment has this dog been exposed to?

If you have disciplined this dog, what method(s) did you use?* This field is required.

Verbal correction

Physical correction

Timeout

Squirt bottle

Redirect to a preferred behavior

Penny can or other item shaken or thrown to distract the dog

Ignore the behavior

Shock collar

Other

You selected 'other'* This field is required.What other methods of discipline did you use?

How does the dog respond to the above discipline?* This field is required.

To your knowledge, has this dog ever been declared vicious and/or dangerous by any legal authority?* This field is required.**You are required by law to disclose the above information to us and to notify the appropriate agency that you surrendered the dog to us.

YESNO

Please list the State, City and County* This field is required.

To you knowledge, has this dog ever been quarantined for biting?* This field is required.

YESNO

How many times? When did it occur? Describe the circumstances.* This field is required.

Is this dog protective of:* This field is required.

Food

Toys

Treats

People

Not Applicable

Please describe the behaviors of this dog when it is being protective of the previous selection(s)

What makes the dog worried, or causes them to behave in a different manner than usual:* This field is required.

Going to the vet

Going in the car

Strangers

Kids

Other animals

Other dogs

Getting nails trimmed

Baths

Crowds

Fireworks

Thunder

Loud noises

Quick movements

Other

You selected 'other'* This field is required.What else makes this dog worried, or causes them to behave in a different manner than usual?

Does this dog have separation anxiety?* This field is required.

Yes, diagnosed by me

Yes, diagnosed by veterinarian

Yes, diagnosed by a trainer

Yes, diagnosed by other

What are the behaviors? What have you done to help with the separation anxiety?* This field is required.

Does your dog have a preference for:* This field is required.

Men

Women

Kids

No Preferences

How would you characterize this dog overall?* This field is required.Select all that apply

Calm

Friendly

Excitable

Cuddly

Clingy

Happy

Shy

Standoffish

Fearful

Submissive

Nervous

Confident

Stubborn

Smart

Outgoing

Dependent

Independent

Other

You selected 'other'* This field is required.How else would you characterize this dog?

Does this dog have any behaviors that adopters should be aware of?* This field is required.

Barking

Jumping on people

Digging

Nipping

Destructive

Too needy

Counter surf

Door dash

Aggressive to people

Aggressive to other dogs

Aggressive to other animals

Other

You selected one or more of the options 'aggressive to people,' 'aggressive to other dogs,' and 'aggressive to other animals.'* This field is required.Please explain what this behavior was, and what actions were taken to correct the behavior

How does this dog behave with adult human family members?* This field is required.

Calm

Friendly

Excited

Playful

Shy

Fearful

Protective

Aggressive

You selected one or more of the options 'fearful,' 'protective,' and 'aggressive.'* This field is required.Please explain the behavior

How does this dog behave with child human family members?* This field is required.

Calm

Friendly

Excited

Playful

Shy

Fearful

Protective

Aggressive

You selected one or more of the options 'fearful,' 'protective,' and 'aggressive.'* This field is required.Please explain the behavior

How does this dog behave with adult visitors to the home?* This field is required.

Calm

Friendly

Excited

Playful

Shy

Fearful

Protective

Aggressive

You selected one or more of the options 'fearful,' 'protective,' and 'aggressive.'* This field is required.Please explain the behavior

How does this dog behave with child visitors to the home?* This field is required.

Calm

Friendly

Excited

Playful

Shy

Fearful

Protective

Aggressive

You selected one or more of the options 'fearful,' 'protective,' and 'aggressive.'* This field is required.Please explain the behavior

How does this dog behave with adults in the general public?* This field is required.

Calm

Friendly

Excited

Playful

Shy

Fearful

Protective

Aggressive

You selected one or more of the options 'fearful,' 'protective,' and 'aggressive.'* This field is required.Please explain the behavior

How does this dog behave with children in the general public?* This field is required.

Calm

Friendly

Excited

Playful

Shy

Fearful

Protective

Aggressive

You selected one or more of the options 'fearful,' 'protective,' and 'aggressive.'* This field is required.Please explain the behavior

What is this dog's medical history?* This field is required.

Who was this dog's veterinarian?

Veterinarian name and/or clinic

Veterinarian/clinic's phone number

Please sign here so we can access this dog's vet records

Clear

Please add any additional information that you feel would be helpful for us or a new owner to know about this dog.* This field is required.

May the new owner contact you for further information?* This field is required.

YESNO

Please leave your name and phone number for the new owner to contact you for further information:* This field is required.

First name

Phone number