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The Inspiration
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Your Name
*
Email
What is your dog’s name?
Dog Breed / Mix
How old is your dog?
Is your dog:
Neutered
Spayed
Is your dog:
Male
Female
Are you the dog’s original owner?
Yes
No
Is your dog micro-chipped?
Yes
No
Microchip Number
Does he/she chew furniture or other household objects?
Yes
No
If yes, please describe:
Is your dog completely housebroken?
Yes
No
If no, check one of the following:
Has occasional accidents]
Sometimes, if left alone too long
Always kept outside
Other
If other please explain:
Can he/she be left alone inside (without incident)?
Yes
No
If yes, for how long?
If no, please describe:
Is the dog ever kept outside?
Yes
No
For how many hours?
How was the dog confined outside?
Chain
Fence
Other
If other please explain:
What type of shelter is provided outside?
Is he/she crate trained?
Yes
No
For how many hours?
Does he/she jump fences?
Yes
No
If yes, how tall is the fence?
Type of fence?
Other means of escape?
Where is the dog kept during the day?
Where is the dog kept at night?
Where does the dog sleep?
Being brushed/groomed?
Yes
No
Does the dog like baths?
Yes
No
Does he/she get into garbage:
No
Inside
Outside
Both
Does he/she enjoy riding in the car?
Yes
No
I don't know
Is your dog afraid of noises/people (i.e. thunder, fireworks, men, animals, etc.)?
Yes
No
If yes, what noises bother them (please be specific)?
Which of the following best describes this animal’s attitude toward other dogs?
Aggressive
Tolerant, but not playful
Reserved/cautious
Happy/Playful
Don’t know
Is he/she good with male dogs?
Yes
No
Is he/she good with female dogs?
Yes
No
Do you have any other dogs?
Yes
No
Do you have any cats?
Yes
No
Which of the following best describes this animal’s attitude toward cats?
Aggressive
Tolerant, but not playful
Reserved/cautious
Happy/Playful
Don’t know
Is this animal good with horses/chickens/farm animals?
Yes
No
Don't Know
What types of animals DOESN’T this dog get along with?
Which of the following best describes this animal’s attitude toward children?
Aggressive
Tolerant, but not playful
Reserved/cautious
Happy/Playful
Don’t know
Is he/she good with children?
Yes
No
Don't Know
If NO, please list age range and how he/she is not good:
Do you have children?
Yes
No
If yes, what were the circumstances?
Has this dog ever growled at anyone
Yes
No
If yes, what were the circumstances?
Has this dog ever snapped at anyone?
Yes
No
If yes, what were the circumstances?
Has this dog ever bitten anyone?
Yes
No
If yes, how many times has it occurred and what were the circumstances?
Has he/she had any obedience training?
Yes
No
What commands does your dog know:
Does he/she walk well on a leash?
Yes
No
Good off leash?
Yes
No
He/she is walked with a
Nylon collar
Choke chain
Harness
Does he/she know any tricks?
Yes
No
If yes, what tricks does he/she know?
When was the last time he/she was at a veterinarian?
Last 3 mos.
Last 6 mos.
Last Year
Last 2 yrs.
More than 2 yrs.
Never
Veterinarian’s name and address (city and state)
Is he/she current on vaccinations?
Yes
No
List any any health problems
How often does he/she eat?
Once/day
Twice/day
3X/day
Free fed
What does he/she eat?
Dry
Canned
YOUR WISHES - please add anything that can help us to place your dog in the best home possible
PLEASE READ THE FOLLOWING AND COMPLETE
Your Full Name
Address
Phone
EXECUTOR OF WILL INFORMATION:
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