What's Your 20?

Thank you for contacting The Pit Stop Rescue for help. We would love to be able to assist you with any problems you may be facing. Please keep in mind that we are a foster based organization so we will do what we can to best assist. Please understand that this questionnaire is to get the most information possible in order to best assist you. This does not indicate that we will absolutely be able to help, only offer advise on how to get you the best assistance. Please be sure to answer all questions to the best of your abilities to help us help you in a speedy fashion.

Name *

First Name Last Name

E-mail *

example@example.com

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Pets Name: *

Pet Breed: *

Pet Age: *

What is the name of your pet's Veterinarian? *

What is your pet's Veterinarian's phone number? *

Is your pet up to date on vaccinations? *

Is your pet up to date on monthly heartworm prevention? *

What is your pets heartworm status? *

Is your pet spayed/neutered? *

Is your pet dog friendly? *

Is your pet cat friendly? *

Is your pet kid friendly? *

How long have you had your pet? *

Has your pet ever been through training with a certified trainer? *

Has your pet EVER shown any signs of aggression in regards to: *

	Yes	No	Unknown
Food
Treats/Toys
People/Kids
Other Pets
Other

If answered "yes" to any above, please explain below: *

Does your pet have any history of biting and/or attacking? *

If answered "yes" to above, please explain below:

Has Animal Control ever been called on your pet? *

If answered "yes" to above, please explain below:

How can The Pit Stop Rescue help you? *

If you are asking for assistance in finding your pet a new home, how long are you able to hold on to your pet? *

If you are asking for assistance in finding your pet a new home, are you able to foster your pet until a new home can be found? If yes, please go to www.thepitstoprescue.com to complete the foster application. *

Any additional information we should know?

Please upload a pictures of your pet here:

Upload a File

By clicking submit, you are acknowledging that this questionnaire does not indicate that we will absolutely be able to help, however, we will do what we can to help and offer any advise that we can to assist you in your situation.

Please allow 2 business days for a response as the amount of emails we receive daily can be overwhelming at times. In the meantime, please visit our resource section on our website, www.thepitstoprescue.com, to get information on other rescues who may be able to offer assistance as well. We encourage you to reach out to as many as you can to make the best of your time as you wait for a response from us.

Thank you,

The Pit Stop Rescue Crew!

How can we help?