Gifted Dog Form

Name

First Name

Last Name

Address

Address line 2

Postcode

Phone number

Email

Dog Name

Breed

Colour

Dog age (DOB if known)

Is the dog microchipped?

Yes

No

Unknown

Is the dog microchipped to you?

Yes

No

Unknown

Microchip Number (if known)

Is the dog vaccinated?

Yes

No

Unknown

Is the dog Neutered?

Yes

No

Unknown

Is the dog up to date with flea treatments?

Yes

No

Is the dog wormed up to date?

Yes

No

If your dog is fully vaccinated, please attach a copy of their vaccination record here. We are able to prioritise fully vaccinated dogs due to not having to isolate them which means we may be able to get your dog in quicker.

Maximum file size: 67.11MB

Reason for bringing your dog into our care?

Where did you originally get the dog?

How long have you owned the dog?

How many previous homes has your dog had?

How many adults live in your home?

How many children live in the home? Please provide ages

How does your dog react around children?

How would you describe your home environment? e.g. busy, quiet, children visiting

Describe how your dog reacts when meeting other dogs outside of the home?

Has your dog lived with other dogs?

Yes

No

How many dogs have they lived with? How many dogs are being rehomed?

If multiple dogs are being rehomed are they related?

Yes

No

Where does each dog prefer to spend their time?

Do the dogs ever play together?

Yes

No

If yes, please describe how they play together

Is there ever any aggressive behaviour displayed between the dogs?

Yes

No

If yes, please provide as much detail as possible?

Is there ever any resource guarding between the dogs? i.e. beds, food, toys

Yes

No

If yes, please provide as much detail as possible

How do the dogs prefer to spend their time when they are together in the same room? e.g. playing, sleeping, avoiding each other

Do the dogs sleep physically touching each other?

Yes

No

Has the dog ever lived with cats?

Yes

No

How does the dog behave around the cat?

The dog and cat must be kept separate

The dog will chase the cat if the cat moves

The dog avoids the cat

The dog is uninterested in the cat

The dog interacts calmly with the cat

Does the dog have any ongoing medical conditions?

Yes

No

If yes, please provide a details

Is the dog currently on any medication?

Yes

No

If yes, please provide a list of medication and dosage

Does the dog have any known allergies or special diet requirements?

Yes

No

If yes, please provide full details

Are there any previous medical concerns or injuries we should be aware of?

Yes

No

If yes, please provide full details

Please provide the name and address of your veterinary practice

How does your dog behave in the home enviroment?

Does not come in the house- kennelled outside

Spends all of their time around people in the home

Spends some time around people in the home but prefers to be alone

Does not like new people coming in the home

Confident, is happy for people to come into the home

Other

Please provide any details you feel may be relevant

Are there parts of your dog's body they do not like to be touched?

Yes

No

If yes, please provide full details

Where does your dog sleep both day and night?

Does your dog like to play with toys?

Will not play with toys

Will play if encouraged

Will occasionally play with toys

Plays with toys regularly

What type of toys does the dog like to play with?

Does your dog Know any commands/phrases?

Sit

Lie down

Stay

Other

Please provide as much information as possible about know commands

Has your dog ever bitten?

Yes

No

If yes, please provide full details

Does your dog get overexcited and scratch or bite during play?

Yes

No

If yes, please provide full details

Have fingers or toes, hands or feet ever been used as toys for your dog?

Yes

No

If yes, please provide full details

Has your dog ever been crate trained?

Yes

No

If yes, please provide full details

Has your dog ever been to a groomer?

Yes

No

If yes, please provide full details

Does your dog currently or have they previously displayed any of these behavioural problems?

Please provide full details for any ticked boxes

If your dog has ever displayed any of the above behaviours, have they been to a vet for the behavioural concern?

Is your dog frightened of anything?

How does your dog usually respond when frightened?

What and when does your dog currently eat? please include type of food i.e., wet or dry, brand, time and frequency of feed

Are there any foods that your dog dislikes or is sensitive to?

Yes

No

If yes, please provide full details

What type of food and water bowls does your dog use? (e.g. ceramic, metal, plastic, slow feeder other)

Is your dog fully house trained?

Yes

Will have occasional accidents

No

If yes, please provide full details

Where does your dog prefer to toilet?

If Other, please provide full details

If your dog in not house trained, where do they toilet?

How would you best describe the outside environment the dog is used to?

If Other, please provide full details

Please provide any further information about your dog that you feel may be relevant

Please attach a photo/s of your dog here.

Maximum file size: 67.11MB

Please tick if you are happy to receive further information from/about the shelter by:

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