Dog Surrender Request Questionnaire







    Reason for surrendering :

    Timeframe for surrender?:

    Are you willing to keep your dog while we work to find him or her a permanent family?:

    Breed:

    Gender:

    Approximate age:

    Weight:

    Where did you acquire your dog? :

    If from a breeder, have you tried contacting them? :

    If from a rescue, please provide their information. :

    How long have you had your dog? :

    Is your dog up spayed/neutered?:

    If no, please explain why not. :

    Is your dog up-to-date on vaccinations?:

    If no, please explain why not.:

    Has your dog received a heartworm test in the last year?:

    If yes, when and what were the results (positive or negative). :

    Has your dog had a fecal test in the last year?:

    If yes, when and what were the results (positive or negative). :

    Is your dog microchipped?:

    What type of food is your dog currently eating?:

    Does your dog have any dietary restrictions/sensitivities we should know about?:

    If yes, please explain in detail. :

    Does your dog have any other medical conditions or concerns we should know about?:

    If yes, please explain in detail. :

    Name of current vet:

    Phone Number of Current Vet:

    How would you describe your dogs personality overall?:

    What kinds of activities or toys does your dog like most? :

    When meeting a new person, how does your dog react? :

    Has your dog been exposed to kids? :

    If yes, please describe how they interact with respectful children. :

    If not tested with children, based on your observations, how do you think they would do with respectful kids under 14?:

    Is your dog good with other dogs?:

    If no, please explain.:

    Is your dog good with cats?:

    Is your dog possessive of food, toys, the couch, the bed, family members etc?:

    If yes, please explain in detail. :

    Is your dog fearful of anything? :

    If yes, please explain in detail. :

    Does your dog have any destructive tendencies? i.e. inappropriate chewing, destruction of furniture, etc. :

    If yes, please explain in detail. :

    Is your dog a climber, digger or escape artist (flight risk)?:

    If yes, please explain in detail. :

    Has your dog ever bitten another human or animal?:

    Where does your dog spend most of their time when you are home?:

    On average, how many hours does your dog spend alone each day? Please provide us with a brief overview of a typical day in your household.:

    Does your dog display signs of separation anxiety when left alone?:

    If yes, please describe to us in detail what this looks like. :

    Is your dog crated while you’re away or are they trusted with free reign of the home? If crated, how long does it take for them to settle in the crate?:

    Please describe your dog's energy level.:

    On average, how much exercise does your dog get each day? :

    Describe how your dog walks on a leash.:

    Is your dog house trained?:

    If no, please elaborate.:

    Does your dog get a mid-day potty break if you're away from the home for more than 8 hours?:

    Describe your dog’s obedience skills. Do they know any basic commands?: sit, stay, lie down, recall, spin, give me five, give me kiss, get off (furniture), come up (furniture)?:

    Have you ever worked with a trainer and / or attended a basic obedience training class with your dog?:

    If yes, please provide more detail.:

    Are there any particular areas that your dog requires extra support and/or training? :

    If your dog’s physical and emotional needs were met, which of the following living arrangements would they be most successful?:



    Describe the perfect home for your dog. :

    Please be aware that completing this questionnaire does not guarantee a placement in our program. We are a foster based rescue and can only intake animals when we have an appropriate foster home available. The above information is used to determine this.