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Pets Name
Date Of Turn In
This field isn't assigned to an Option List.
Reason For Surrender
Your Phone
Your Email Address
Pets Age
Neutered *
Heart Worm *
Where Did You Get Your Pet And How long have you had it?
Medical History
List Medications
House Trained *
Destructive? *
Crate Trained? *
Food Or Toy Aggressive *
Children Friendly? *
Cat Friendly *
Afraid Of Thunder? *
Afraid Of Loud Noises? *
Afraid Of Crying? *
Afraid Of Screeming? *
Afraid Of Men? *
Afraid Of Hats? *
Aany Other Fears Not listed?
Has the dog always lived inside? *
How long has the pet been left alone daily? *
How many times does the pet go out during the day? *
Last time out at night? *
First time AM? *
What does the pet eat? *
How many cups per meal? *
Do you mix the food? If Yes With What? *
Who was the main caretaker? *
Has the pet been in a private kennel? If Yes list name and number. *
What commands does the dog know? *
Check those the dog does regularly *
Have you done any formal socialized training? *
Special Comments or Conditions
Vets name and phone? *
Additional Comments
Your Name *
Your Address *