Dog Intake/Behavioral Form

Dog Intake/Behavioral Form

Completing this form does not guarantee your dog's submission into our rescue. A volunteer will contact you to discuss the next step.
Name*

First NameLast Name
Phone*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
DOG & HOUSEHOLD INFORMATION
Dogs Name*
Age*
Sex*

MaleFemale
Spayed/Neutered*

YesNo
Is the Doberman*

PurebreedMix
Age*
Tail*

DockedNatural
Where did you get your dog?*

CKC registered breederBackyard BreederOut of countryRescueFamily member / FriendOther
How long have you had the dog?*
Why are you inquiring about surrendering your dog today?*
How many owners has your dog had?*

Including yourself, how many people of the following ages live in your home?*

	FEMALE	MALE
00 - 03
04 - 09
10 - 17
18 - 29
30 - 59
60 +

What other animals has your dog lived with?*

no other animalsdogscatsOther
BEHAVIOR

Your dogs usual behavior

How does your dog usually behave towards people they know?*

	never encounter	friendly	afraid	show teeth/growl	snaps	bites	other
men
women
children

How does your dog usually behave towards people they DO NOT know?*

	never encounter	friendly	afraid	show teeth/growl	snaps	bites	other
men
women
children

How does your dog usually behave towards animals they know?*

	never encounter	friendly	afraid	show teeth/growl	snaps	bites	other
dogs
cats
Other

How does your dog usually behave towards animals they DO NOT know?*

	never encounter	friendly	afraid	show teeth/growl	snaps	bites	other
dogs
cats

Comments on answers above
How does your dog usually react when an unfamiliar person approaches or enters the yard or house?*

friendlyafraidbarksshows teeth/growlswill bite
Is your dog housetrained?*

yesnopartially
Is your dog crate trained?*

yesnopartially
How does your dog let you know they need to go out?*
Where does your dog spend the majority of their time?*

inside the house, runs freeinside the house, cratedoutside the house, runs free in yardoutside the house, kenneloutside the house, tied upOther
How many hours a day is your dog left alone without a human?*

never1-3 hours4-8 hours9-12 hoursover 12 hours
When left alone, is he/she...*

outdoorsfree roam in homeconfined to a roomcratedOther
When left alone, does your dog usually show any of the following behaviors?*

destroy household itemsurinate/defecatebarkcrynone of theseOther
When your dog plays, do they typically...*

jumpsgrowlsbarksbites lightlybites hardnone of theseOther
What toys does your dog like?*

ballsfrisbeeplushsqueakytug toynoneOther
What games does your dog like?*

fetchtugchasewrestlingnoneOther
Is your dog scared of anything*

yesno
If yes, please explain
Please tell us any bad habits your dog may have*
Is your dog allowed on furniture?*

yesno
Where does your dog usually sleep at overnight?*

crateflooryour bedcouchkids beddog bedoutsideOther
What commands does your dog know?*

no commands knownsitdownstaycomeleave itplaceheelOther
How do you exercise your dog (Please select all that apply?)*

Fenced in dog parkfenced yardoff leash hikingdog walkeron leash urban walksIndoor gamesDog DaycareOther
Describe your dogs leash skills*
Describe your dogs off leash skills? Do you trust he/she will come back when off leash?*
Describe your dogs reaction if a person or other dog attempts to take a toy they are playing with.*
Describe your dogs reaction around food (any resource guarding?) with both people and other animals*
Describe your dogs reaction if touched when sleeping.*
Does your dog have problems riding in car?*

yesnodon't know
If yes, please explain
Has your dog escaped your property 2 or more times in the last 6 months?

yesno
If yes, please explain
AGGRESSIVE BEHAVIOR

(behavior that has ever happened)
Has your dog ever attacked or bit a person?*

yesno
If yes, please explain
Has your dog ever attacked or bit another dog?*

yesno
If yes, please explain
Has your dog ever attacked or bit a cat?*

yesno
If yes, please explain
Has your dog ever attacked or bit farm animals? (chickens, horses, cows, goat, pig, sheep, etc...)*

yesno
If yes, please explain
MEDICAL
Please list all veterinarians that have seen your dog, including address and number.*
Does your dog see a veterinarian at least once a year?*

yesno
Is he/she spayed/neutered?*

yesno
What vaccinations has your dog recieved?*

rabiesdhhpbordatellanone
Are vaccinations current?*

yesno
Has your Doberman been tested been tested for Dilated Cardio Myopathy (DCM), heart murmur, Von Willebrand disease (VWD)?*

yesno
If yes, what were test results
If yes, when is the next dosage due?
Is your dog microchipped?*

yesno

Has your dog ever shown any of the following behaviors when handled by a vet or groomer.*

	never done	shows teeth/growls	snap	bite	none of these
examine
restrain
administer shots
bathe
clean ears
trim nails
take blood

Does your dog have to be muzzled at the veterinarians?*

yesno
Does your dog have any past or present health problems?*

yesno
If yes, please describe
Is your dog currently taking any medication?*

yesno
If yes, please list medications
Does your dog suffer from any allergies?*

yesno
If yes, please explain
FEEDING
What type of food does your dog eat?*

canneddrysofttable scrapsrawhome cooked
How many times a day is he/she fed?*

1 time2 times3 timesfree feeds
How much is fed per feeding?*

1 cup1 1/2 cup2 cups2 1/2 cupsnot sure, just fill the bowl upOther
OTHER
Please feel free to tell us any other information you feel is important.
Please upload a full body photo of your pup*

Cancelof
Please upload a up close head shot of your pup*

Cancelof
Please upload any records you have for the boxer

Cancelof
Date

MonthDayYear
Date
Signature

Powered by Jotform SignClear
Should be Empty:

Dog Intake/Behavioral Form

DOG & HOUSEHOLD INFORMATION

BEHAVIOR

AGGRESSIVE BEHAVIOR

MEDICAL

FEEDING

OTHER