TBVC RESCUE INTAKE QUESTIONNAIRE

For the health of your Vizsla, it's very important that you answer all questions as truthfully as possible. If a question does not apply to youu or your dog please answer "N/A". We are here to help and the more detail information provided the better we can help your Vizsla.

Owner's Name

Owner's Address

Owner's Email

Owner's Cell

Dog's Name

Is your dog microchipped?

If microchipped, please provide #:

Date of birth?

Age?

Is the dog spayed/neutered?

If no, for female when was her last season?

How many litters has your female had?

What is the dog’s weight?

Is your dog's tail cropped?

Is your dog's dew claw removed?

What is the name of breeder? Or Name of pet shop?

Is the dog house trained?

Did the dog go to obedience school?

Is the dog good on a leash?

Is the dog good off leash?

Does your dog have a good recall?

Is the dog a counter surfer?

Does the dog sleep through the night?

Is the dog crate trained?

Is the dog good with other dogs?

Is the dog good with cats?

Is the dog good with children?

Does the dog have any destructive habits?

Does the dog have separation anxiety?

Does the dog have any food aggression?

Any other aggression?

Any history of biting?

Is the dog allowed on the furniture?

Can the dog swim?

Is the dog afraid of thunderstorms?

Is the dog afraid of fireworks

How long can the dog be left alone?

Do you crate when you leave the house? Free roaming?

How does the dog travel in the car?

Does the dog know how to use a doggie door?

Where do the dog sleep at night?

How much exercise the dog get every day?

What commands do the dog know? (sit, stay, etc)

What time does the dog go to bed?

What time does the dog usually wake up?

Veterinary Clinic Name your dog is treated at?

Date of last treatment?

Is the dog up to date with vaccines?

Is the dog on heart worm preventive?

Is the dog on any medication?

Can we have access to the dog vet records?

Does the dog have any incontinence?

Is the dog cooperative for nail trimming?

If not, do you take the dog for nail trimming?

What kind of food is the dog eating?

How much is the dog eating food/day and when?

Comment

Provided detailed reason you are surrendering your dog

Release of Dog to Tampa Bay Vizsla Club Rescue inc.

(Must be completed and witnessed before we can proceed with rescue)

I,

Type your name

, the undersigned, declare that I am aware that I am the

owner (or finder) of the following dog:

Type dog's name

and that I desire the ownership of said animal be transferred to the Vizsla Rescue Committee of the Tampa Bay Vizsla Club. By signing this document, I agree to relinquish all future claim to this animal, and I hereby release the Tampa Bay Vizsla Club, its Vizsla Rescue Committee, its agents, volunteers, and their heirs, if any, and all responsibility for actions required to best provide for this animal’s future welfare.

Individual Owner(s)

Name

Date

Signature of owners

Sign with your mouse (computer) or finger (mobile).