Owner Surrender Questionnaire
Please fill out this questionnaire if you would like us to consider taking your dog into Doberman Rescue of Atlanta.
Dog Owner's Name
*
First Name
Last Name
Dog Owner's Current Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Dog's Name
*
Dog's Gender
*
Male
Female
Dog's Breed
*
Doberman, Doberman Mix, Rottweiler, etc.
Dog's Age
Color
*
Black
Red
Fawn
Blue
Albino
No Sure
Ears
*
Cropped
Natural (not cropped)
Not sure
Tail
Docked
Natural (not docked)
Not Sure
Which vet clinic has treated this dog?
Name of vet clinic
Vet Clinic Phone Number
Please enter a valid phone number.
Vet Clinic Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you owned this dog?
Where did you acquire this dog ?
(breeder, shelter, rescue, etc.)
Why do you want to surrender this dog?
*
Medical Information
Has this dog been spayed or neutered?
*
Yes
No
I don't know
Do you know when this dog was last vaccinated?
*
Yes
No
Date of last vaccinations (approximate is ok)
Approximate date dog was last vaccinated
Do you know when this dog last had heartworm prevention (like Heartgard)?
*
Yes
No
When did this dog last have heartworm prevention?
Any known medical issues or allergies?
Dog Behavior/Temperament
Is this dog comfortable with...(only check a box if you know the dog does not have issues with that selection)
Male Dogs
Female Dogs
Cats
Children
Men
Women
Strangers
Riding in the Car
Is this dog housebroken (does he know not to go to the bathroom indoors)?
*
Yes
No
Not sure
Is this dog crate trained?
*
Yes
No
Not sure
Is this dog leash trained?
*
Yes
No
Not sure
Does this dog....
*
Jump fences
Dig
Chew
Guard food
Guard toys
None of the above
Does this dog bark...
*
Never
Occasionally
Excessively
At strangers and noise
Not Sure
Has this dog ever bitten a human?
*
Yes
No
Unknown
Describe the situation where the dog bit a person.
Have you ever received any citations from any governmental entity or been sued because of this dog?
*
Yes
No
Describe the situation which led to you being sued or issued a citation.
Has this dog ever attacked another dog or gotten into a fight with another dog, even if it was one of your own dogs?
*
Yes
No
Unknown
Describe the attack or dog fight.
Does this dog have separation anxiety?
*
Yes
No
Unknown
Describe the separation anxiety.
Does this dog allow you to take away bones, toys and food?
*
Yes
No
Unknown
Does this dog try to keep other dogs or people away from his/her owner?
*
Yes
No
Unknown
List any commands this dog knows.
Does your dog have any specific preferences for interaction?
(e.g., likes belly rubs, dislikes being picked up)
Has your dog undergone any training, and if so, what type?
Does your dog exhibit any fears or phobias?
(e.g., thunderstorms, fireworks)
Does your dog show any signs of aggression?
(towards people, other dogs, or specific situations)
How does your dog behave in new environments?
Does your dog have any special needs or preferences you'd like to share?
(e.g., dietary restrictions, favorite toys)
Is there anything else you'd like to add about your dog's behavior, personality, or any specific concerns?
Upload a photo of your dog (optional)
Date
-
Month
-
Day
Year
Submit
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