| Phone: |
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| Email address: |
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| Dog's Name: |
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| Sex: |
Spayed or Neutered |
| Date of Birth: |
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| Breed: |
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| How long have you had your dog?: |
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| Are you the original owner? |
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| Where did you get your dog?: |
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| Has your dog ever lived outside SD county?: |
If yes, where?: |
| Why are you surrendering your dog?: |
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| Who has the dog lived with?: |
Adult women
Adult men
Seniors
Dogs
Cats
Children-ages please:
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| How does the dog react around children?: |
Playful
Afraid
Tolerant
Snappy
Very loving
Too active for small children
Never been around children
Calm (avoids children)
Nips or bites
Protective
Growls
Acts aggressively
Other:
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| Does your pet have a preference for?: |
Men, Women, Children,Other animal(s):
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| How many hours a day is dog left alone?: |
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| Where did the dog spend most of it's time?: |
Always outside
Mostly outside
In garage
Outside unless we were home
In crate
In or Out at will
Always inside
Please describe how dog reacted to being left alone:
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| Where does your dog spend it's time when
you are home?: |
Inside-Hours:
Outside-Hours:
Free access in and out |
| Where does your dog spend it's time when you are away?: |
Inside-Hours:
Outside-Hours:
Free access in and out
Garage |
| When inside, is the dog confined?: |
If yes, how was the dog confined:
Baby gate
Doors closed
Crate
Other:
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| Is this dog restricted from any areas?: |
If yes, where?:
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| While outside, my dog was: |
Never outside off leash or unsupervised
No confinement, allowed to run
Fenced yard. Size?:
Dog run. Size?:
Confined in garage
Tethered by chain or cable
Invisible fence |
| If this dog is kept in a fenced yard or a run, how does it behave?: |
Rests
Plays
Paces
Chews
Whines
Howls
Digs
Tries to escape:
Digs under
Jumps over
Barks: At what?:
If the dog escapes, where does it go?
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| Where does the dog sleep?: |
- Inside house? Which room?
- In a crate in house? Which room?
- Garage?
- Outside? Where
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| If crated, this dog was?: |
- Calm, sleeps
- Anxious, whines, barks, drools
- Anxious at first, then calms down
- Cannot be crated
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| Is he/she housetrained? |
If no, why not?:
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| How do you know when this dog needs to go potty?: |
Goes to door, barks, paces, scheduled walks,
lets him/herself out doggy door
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| Where does this dog go potty?: |
Newspaper, pads or similar product, litter box, walks,
yard, through dog door, let out by person, other:
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| How often does this dog urinate or defecate in an inappropriate place?: |
Never
2-3 times per week
Occasionally has accidents
This dog has accidents when left alone for
hours
Accidents are urine only
This dog has accidents everyday
Accidents even when people are home |
| What kind of exercise did this dog receive?: |
Walked: How often?
Taken off leash in park/country: How often?
Placed on cable or run outside
Put out in fenced yard
No regular exercise |
| Check all traits that describe your dog's personality and behavior?: |
Friendly
Clingy
Aloof
Hyper
Mellow
Protective
Playful
Mouthy
Fearful
Vocal
Cuddly
Confident
Submissive
Smart
Independent
Lap Dog
Stubborn
Goofball
Couch potato Other:
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| What makes your dog worried, or causes it to behave in a different manner than usual?: |
Children
Going in the car
Other dogs
Fireworks
Getting nails trimmed
Strangers
Going to the Vet
Other animals
Crowds
Grabbing the collar
Taking a bone or toy away
Explain:
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| Does this dog have separation anxiety?: |
Was the separation anxiety diagnosed by:
You
Vet Other:
What have you done to end the separation anxiety?
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How does this dog react to strangers?:
(ie: Excited, scared, wagging tail) |
At home:
On walks:
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| How does dog react around strange dogs?: |
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| How does dog react around cats?: |
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Does the dog have any of
the following behaviors?: |
Jumps/climbs fences
Digs
Chews
Barks Excessively Marks territory
Plays too rough Jumps on people
Chases cats,cars, or bicycles etc.
Escape Artist
Other:
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| Have you ever tried to correct these behaviors?: |
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| If yes, what method did you use?: |
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| What training equipment has this dog been exposed to?: |
Clicker
Treats
Choke Chain
Harness
Head Halter (type and size):
Prong/Pinch collar
Electronic collar
Was this equipment successful for you and your dog?:
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| If you have disciplined this dog, what method(s) did you use?: |
Verbal correction
Physical correction
Timeout
Squirt bottle
Ignore the behavior
Penny can/other item shaken/ thrown to distract the dog
Other:
How does the dog respond to the above displine?:
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| Has the dog EVER: |
Bitten
Snapped
Growled at or shown aggression towards any person?
If yes, please explain:
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| Has the dog EVER: |
Bitten
Snapped
Growled at or shown aggression towards another animal?
If yes, please explain:
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| Is the dog protective of food, toys, family members, or property?: |
If yes, please explain:
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| Any health problems? |
If yes, please explain?:
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| What types of medications has it used?: |
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| Does your dog need to be on a special diet? |
If yes, what type of special diet?:
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| What would be his/her ideal home?: |
With another dog
Free access in and out
Active home
Mellow home
Children
(please give ages)
Other:
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| What are his/her favorite things to do?: |
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| Additional comments that will help us find your dog a new home? |
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| After you have reviewed your profile please type RCHS for security purposes: |
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