Big Fluffy Dog Rescue Intake Form

Please fill this out as completely as possible. More information is better than less. Please do not leave out information about your dog in order to get a home for him/her! The information is important so that we can find a suitable match for your dog’s disposition, age and health.

If you own the dog and are surrendering it, please give us the dog’s veterinary records, and all collars, tags, bowls, toys, favorite blanket, and a week’s supply of his current food, when you surrender him or her, to help them acclimate to new surroundings.

If you are a shelter seeking our help, please provide as much information as you have, and note the best way to reach you and the ID number of the dog, if applicable.

About the Dog

What is the dog's name? *

The dog is: *

Is the dog in a shelter? If so, where. *

Who are you working with at BFDR to surrender your dog? *

Do you own this dog? *

Yes

No

If an owner, why are you surrendering your dog?

How old is the dog? *

What breed is the dog? *

How much does the dog weigh? *

Is the dog microchipped? If yes, put number below. *

Microchip # *

What color is the dog? *

What color are the dog's eyes? *

Describe any distinguishing markings:

Upload a picture here (1 MB limit):

Where the dog came from

Are you the original owner? *

Yes

No

If no, where did you get the dog?

Are you a shelter volunteer/employee? *

If you are not the original owner, do you know where the dog came from?

yes

no

If yes, please explain:

Did your dog come from a breeder? *

yes

no

If yes, who is the breeder? Put N/A if not from a breeder. *

Was the breeder contacted about surrendering/returning this dog?

yes

no

Why do you want rescue to take this dog? *

Did the dog come from: *

How long have you had this dog? *

If the dog was a stray, what steps did you take to find the owner? If not a stray, put N/A. *

If the dog was a stray, when and where was the dog found? If not a stray, put N/A. *

Health information

Is the dog spayed or neutered? *

yes

no

Does this dog have a regular vet? *

yes

no

If yes, give the name of vet. If no, put N/A. *

Vet Phone #. If none, put N/A. *

Date of last vet visit: *

Is the dog up to date on rabies shots? *

Is the dog up to date on distemper/parvo shots? * 🛈

Is the dog up to date on bordetella shots? *

List any other shots (lyme, etc) *

Has the dog been tested for heartworms? *

Is the dog heartworm negative? *

What brand of food does the dog eat? *

How much does your dog eat per day? *

Does your dog have any health problems? *

If yes, please describe the illness or health problem: *

Does your dog have any of the following problems (check all that apply)? *

List any medications your dog is taking and how often. Put N/A if no medications. *

The dog's behavior

Is the dog good with all people? *

yes

no

don't know

Is the dog good with children? *

yes

no

don't know

Is the dog afraid of:

Has this dog lived with children? If yes, what ages and how was he with them? *

Is the dog good with other dogs? *

Is the dog good with cats? *

Has this dog lived with other dogs or cats? If so, please explain below and include information about how the dog got along with them. *

Has this dog ever been used as a working dog or livestock guardian dog? *

Is this dog housebroken? *

Is this dog crate-trained? *

Describe any bad habits this dog has? *

Describe any commands/tricks this dog knows: *

Is the dog prone to bolting out the door/gate? *

Is the dog good off-leash? *

Is the dog afraid of thunder/loud noises? *

Explain: *

Does the dog have separation anxiety? *

Explain: *

Has this dog ever bitten anyone? *

If yes, please explain the circumstances of the bite: *

If the dog has bitten someone, did the bite require medical attention? *

Where does the dog spend the day (check all that apply) *

Where does the dog spend the night? *

Please note anything here that you think we should know about the dog, including date to be put to sleep if in a shelter. *

I understand that I am asking Big Fluffy Dog Rescue to take a dog from me or from my organization. I understand that if Big Fluffy Dog Rescue agrees to take this dog into rescue, that this is an irrevocable transfer of ownership of the dog to Big Fluffy Dog Rescue. By signing below, I certify that I have provided true and correct information and that I have read and understood the agreement.

Name *

Date *

Street Address *

City *

State *

Zipcode *

Phone *

Email address *