Animal Intake Form
Harmony Dog Rescue
Today's Date:
-
Month
-
Day
Year
Date
Owner's Name:
First Name
Last Name
Date of Birth:
Email:
example@example.com
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Best way to contact you:
Email
Call
Text
In case of emergency contact name and phone number:
Briefly explain why you need temporary foster care for your dog:
Dog's name:
Age:
Sex:
Breed:
Color:
Weight:
Is your dog spayed/neutered?
Yes
No
Is your dog crate trained?
Yes
No
Is your dog housebroken?
Yes
No
Does you dog travel well in a car?
Yes
No
Does your dog get along with children?
Yes
No
Does your dog get along with other dogs?
Yes
No
Does your dog get along with cats?
Yes
No
How does your dog do walking on a leash?
Under what circumstances does your dog exhibit aggressive or fearful behavior (ie when walking/sees other dogs, lighting/thunder).
Has your dog ever bitten anyone?
If yes, please explain circumstances:
Other behavioral concerns:
What type of food do you feed your dog? (Dry and canned)
Do you give your dogs treats/snacks/bones? If so, please list below:
Does your dog have any food allergies?
Date of last vaccinations (Rabies, DHPP, Bordetella)
Is your dog on any medications? If yes, please list.
Veterinarian:
Are there any other health or medical concerns we should be made aware of?
Anticipated length of foster care needed:
How did you hear about us?
Signature
Continue
Continue
Should be Empty: