Please complete form and click submit

Your Name: 

Home Phone Number:

City

E-mail:

Dog's Name: 

Age of dog:

Gender:   Male   Female

Breed: 

Is the dog spayed/neutered? Yes No

Is the dog microchipped? Yes No 

How long have you had the dog?

What is the dog's history? 

Where is the dog kept when unsupervised? 

Where is the dog when supervised? 

Does the dog use a doggie door? Yes No 

How many people does the dog live with now? (If any children are present, please include their age)

What other animals does the dog live with now? 

How does the dog relate to the other animals in the home? 

How does the dog react to children?
 

How does the dog react to guests in the home?
 

Does the dog walk on a leash well? Yes No

Has the dog ever shown any food or treat aggression? (Please be honest) Yes No

What type of food does the dog eat and what is the feeding schedule?

Where does the dog sleep?
 

Has the dog ever been in a crate? Yes No Don't know

Does the dog ride in the car well? Yes No Don't know

What veterinarian does the dog see?

Has the dog ever bitten anyone even in a playful manner? Yes No Don't know

Has the dog ever bitten or shown aggression toward another animal (even if the other animal started it)? Yes No Don't know

Have you tried to place the dog yourself? Yes No

Can you think of any situation that would be ideal for your dog to be placed into?

Can you think of any situation that you think should be avoided in placement?

Please feel free to add any information that you feel may be relevant or helpful in placing your dog.