Dog Surrender Form
To have your dog considered for intake, please complete this form. If we are able to take your dog, we will follow up via email.
Your dog's age: *
Is your dog microchipped *
- Yes
- No
Your dog's current weight: *
Is your dog: *
- Male
- Female
Why are you surrendering your dog? *
Please include as much information about the situation as possible.
- {name}
Has your dog bitten a person? *
- Yes
- No
If we could provide information that could help or resolve the issues you're having, would you be interested in keeping your dog? *
- Yes
- No
- Maybe
Where did you acquire your dog? *
Has your dog been spayed/neutered? *
- Yes
- No
- Unsure
Is your dog on a special diet, such as prescription food? *
Is your dog current on all vaccinations? *
- Yes
- No
- Unsure
In the past year, has your dog been diagnosed or treated for any of these conditions? *
Select all that apply
- Allergies
- Epilepsy/seizures
- Hip dysplasia
- Ringworm
- Arthritis
- Heart murmer
- Kennel cough
- Skin problems
- Diabetes
- Heartworm disease
- Liver disease
- None
During the day, is your dog kept: *
- Inside
- Outside
- In and out throughout the day
Is your dog crate trained? *
- Yes
- No
- Unsure
Does your dog exhibit any of the following behaviors? *
- Very high energy
- Shy/hiding
- Shut down
- Leash reactivity (barking/lunging in a seemingly aggressive manner)
- Separation anxiety
- Reactivity towards strangers (barking/lunging at guests in or outside of the home)
- None
How does your dog walk on leash? *
Has your dog ever been aggressive towards other dogs? *
Has your dog ever been aggressive towards other animals (such as cats)? *
How does your dog behave around cats? *
How does your dog behave around other dogs? *
How does your dog behave with visitors/new people? *
How does your dog behave around children? *
Has your dog regularly been around children? *
- Yes
- No
- Don't know
Does your dog have any behaviors, quirks, or habits that you are not fond of? *
Please describe in detail
- {name}
Is there any additional information that you think might be helpful for us to know? *
- {name}
If we are able to accept your dog, do you agree to pay a surrender fee? *
Please upload a photo or video of your dog *
Over Limit: attachment upload disabled
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