Is the animal over 5 months old?
*
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Yes
No
First Name
*
Last Name
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Best Phone Number
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Email
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Address
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City
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State
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Zip
Number of puppies
*
Genders, if known:
Approximate date of birth:
*
-
Month
-
Day
Year
Date
Puppy Breed
Best guess based on appearance
How long have you been caring for the puppy/litter?
Reason for surrendering puppy/litter?
Are all the puppies from the same mother?
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Yes
No
Where did you get the puppy/litter?
Would you like to participate in our Spay The Mom Program?
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Yes
No
Is the puppy/litter social and used to be handled?
Does the puppy/litter have any health issues?
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No
Yes
If so, what health issues?
Is the puppy/litter on any medication?
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No
Yes
If so, what medication?
Has the puppy/litter been seen by a veterinarian?
Please Select
No
Yes
Pet Name
*
Pet Gender:
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Spayed Female
Neutered Male
Female - unaltered
Male - unaltered
Breed:
*
Best guess based on appearance
Dog Age:
*
How long have you owned this dog:
*
Where did you get the dog?
*
Reason for surrender?
*
Has this dog ever bitten a person?
*
Please Select
No
Yes
If yes, please explain the circumstances:
Has the dog ever attacked another animal?
*
Please Select
No
Yes
If yes, please explain what happened:
How does this dog interact with other dogs?
*
How does this dog respond to strangers / visitors?
*
Does this dog escape the yard?
*
Please Select
No
Yes
If yes, please explain:
Does this dog have any health concerns that may need to be addressed?
*
Please Select
No
Yes
If yes, please explain the concerns:
Has this dog been seen by a veterinarian in the past year?
*
Please Select
No
Yes
Name of the Vet/Clinic:
*
Will you, the owner, be bringing the dog to Woods?
*
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Yes
No
If no, who will be bringing the dog?
Please upload a photo of your pet here:
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