Rehome Questionnaire

Step 1 of 4 - Owner's Information

25%

Owner's Name(Required)

First Last

Owner's Address(Required)

Street Address Address Line 2 City State ZIP Code

Owner's Phone Number(Required)

Owner's Email Address(Required)

Photo Of Your Dog

Drop files here or

Max. file size: 512 MB, Max. files: 5.

Please attach a current picture(s) and/or video. If you are unable to upload pictures/video, please email to [email protected] (option to attach files) PLACE HOLDER. NOT A GREAT SOLUTION. WORKING ON IMPROVING

Why are you rehoming your dog?(Required)

Please be completely honest and as specific as possible. This will help the team in finding the perfect forever home.

Dog's Name(Required)

Dog's Birthday If Known

Dog's Age Years

Dog's Age Months

Dog's Gender(Required)

Male

Female

Dog's Breed(Required)

Please put your best guess if breed is unknown

Dog's Weight(Required)

Is your dog spayed/nuetered?(Required)

Yes

Unknown

How quickly are you looking to remove him/her from your home? Can you assist in transporting him/her?(Required)

Is your dog microchipped?(Required)

Yes

Unknown

What is the name on Microchip Registration?(Required)

Please provide your current veterinarian office, doctor's name, address, and phone number:

Please attach medical records. If you are unable to upload please email records or call your vet and ask that they send all vet records to [email protected]

Drop files here or

Max. file size: 512 MB, Max. files: 10.

Is your dog potty trained?(Required)

Yes

If not, please explain the issue you have with potty training here.

Is your dog crate trained?(Required)

Yes

If not, please explain the issue you have with crate training here.

Does Your Dog Shed?(Required)

Yes, Lots

Yes, Very Little

Has your dog lived with you since they were a puppy?(Required)

Yes

If not, where was h/she prior and why did s/he was she re-homes?:

Has she had any litters of puppies?

Yes

Unkown

Is your dog up to date on shots?(Required)

Yes

When was their last visit with the Vet?(Required)

Describe their overall medical health(Required)

Is he/she on any flea & tick and/or heartworm preventative?(Required)

Yes

What brand are they taking?(Required)

Is your dog good with children, adults (men and women) & strangers?(Required)

Has s/he been around other dogs *outside* your home?(Required)

Yes

How does s/he interact with them?

Has s/he been around other adults humans *outside* your home?(Required)

Yes

How does s/he interact with them?

Are there children in your home?(Required)

Yes

Please list children's ages

Has s/he shown any signs of aggression or "resource guarding" (resource guarding can be guarding of food, crate, toys, humans, etc) towards any animal or human?(Required)

Yes

Please explain

Has he/she ever; bitten, lunged, shown teeth, snapped, broken skin to any humans and/or animals?(Required)

Yes

Please explain

Any separation [mild-extreme] anxiety?(Required)

Yes

Please explain

Would you consider your dog a flight risk? Running out of open doors, jumping fences, etc.(Required)

Yes

How does your dog get exercise?(Required)

Does your dog have any allergies?(Required)

What items, if any, will you be donating along with the dog? (Ex. food, crate & size, collar, leash, etc.)(Required)

What brand and flavor dog food are you feeding him/her?(Required)

I certify that all information provided above is truthful and accurate, and I am liable for any inaccuracies in the bite history.(Required)

I agree

Signature(Required)

I certify that all information provided above is truthful and accurate, and I am liable for any inaccuracies in the bite history.

By signing this form, I state that I am the owner of the animal(s), who is/are the subject of this Animal Surrender Form, hereinafter referred to as “the animal”. To my knowledge, no other person has any right to this animal. I hereby surrender all rights to the animal to Doodle Rock Rescue. I understand that once I relinquish the animal, the animal will not be available to be returned. I have read and understand the terms of this Animal Surrender Form.(Required)

I agree

Signature(Required)

I certify that all information provided above is truthful and accurate, and I am liable for any inaccuracies in the bite history.

Rehome Questionnaire

Rehome Questionnaire Form