:
Male or female?: Male Female
Spayed or Neutered?:
No Spayed Neutered Unknown Unanswered
If intact, are you planning to have your pet spayed or neutered?:
Yes No Unanswered
Dog's Age or Date of Birth:
Dog's Primary Color(s):
Is your dog current on all vaccinations INCLUDING RABIES?: Yes No Unanswered
Does your dog have a microchip or tattoo?:
Yes No Unanswered
Do you have AKC or SV papers on your dog?:
Yes No Unanswered
Where did you get your dog from and how long have you had him/her?:
If from a breeder, the breeder's name and/or kennel name:
How does your dog typically respond to strangers? (please check all that apply):
Submissive
Submissive
retreats / fearful
lunges & barks
outgoing and friendly
O.K. if not touched
Growls/aggressive
readily accepts petting
my dog is never exposed to strangers
How many hours a day are you typically away from home?
What other pets reside in your home (please include gender & breed)?
EXACTLY where do you keep the dog when you are not home? (Please be specific, i.e., loose outside, outside in a kennel, indoors free, indoors in a crate, in the laundry room, etc.:
Is this an indoor or an outside dog?:
Indoors Outside Unanswered
EXACTLY where does your dog sleep at night?:
Is your dog reliably housebroken?:
Yes No Unanswered
Is your dog crate trained?:
Yes No Unanswered
Is your dog destructive?:
Yes No Unanswered
Has your dog ever been left loose in the house while no one was home?:
Yes No Unanswered
Does your dog panic when left alone (i.e., barking, pawing at blinds or under doorways, scratching on doors, escaping, vocalizing and otherwise manifesting [separation] anxiety)?:
Yes
Has your dog had ANY formal (obedience) training/classes?:
Yes No Unanswered
If yes, where, when and with whom?:
Is your dog well socialized (i.e., FREQUENTLY taken OFF its home property and exposed to strangers, strange dogs, strange things and public places?:
Yes No
Do you walk this dog often?:
Yes No Unanswered
If yes, how often and for how long?:
If yes, do you usually walk to the same place most, if not all, of the time?:
Yes No Unanswered
Does your dog walk well on a leash or does he/she pull?:
Yes No, pulls Unanswered
Does your dog ride well in a car?
Yes No Unanswered
If no, please explain (i.e., gets car sick, jumps in the front seat, etc.):
Has your dog been exposed to the following? (Please check) How does your dog get along with each? If your dog has had exposure, please elaborate on how he/she behaves with each:
Kids
Toddlers (4 and under)
Cats
Small Dogs
Unfamiliar Dogs
If you had to use TWO of the following words ONLY, how would you describe your dog?
Submissive
Aggressive
Fearful
Confident
Skittish/Shy
Nervous/Neurotic
Hyperactive
Overly Protective
Dominant
Does your dog bolt, jump or escape often?:
Yes No Unanswered
Does your dog have any health issues, including allergies?:
Yes No Unanswered
If yes, please elaborate:
Is your dog on any medication?:
Yes No Unanswered
If yes, please elaborate:
Does your dog have hip dysplasia or arthritis?:
Yes No Unanswered
Does your dog have any behavioral issues?:
Yes No Unanswered
If yes, please elaborate:
Has your dog ever bitten anyone?:
Yes No Unanswered
Has your dog ever attacked another dog?:
Yes No Unanswered
Does your dog know how to swim?:
Yes No Unknown Unanswered
Do you have any other pets (i.e., ferrets, reptiles, horses, livestock, etc.)?:
Yes No Unanswered
If yes, please state what other pets and how your dog gets along with them:
Does your dog show a preference for either men or women?:
Yes, Men Yes, Women No Unanswered
Are you considering surrendering your dog?
Have you recently had any significant changes in your household such as moving, new pet, new people divorce, change in schedule, new baby?:
Yes No Unanswered
If so, what changes have occurred?
When and where do you feed your dog?
Do you feel you have enough time to interact with your dog?:
Yes No Unanswered
Do you feel that your dog has sufficient physical exercise and mental stimulation?:
Yes No Unanswered
Is there a family member that does not want the dog around?:
Yes No Unanswered
Are you willing to consider training and/or attend an obedience class?:
Yes No Unanswered
Are you working with any other agencies or rescue groups?:
Yes No Unanswered
What is the date (month and year) of your dog's last vet visit and the reason for the visit?:
If you have access to a digital camera, it would be very helpful if you could Email Steff at SWGSDRESCUE@AOL.com
several photos (taken outdoors during the day) of your dog. We would prefer a face (front) shot, a standing (side) shot and a sitting (front) shot if possible. JPEG attachments are best.
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..Please don't wait for us to call you;
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