Legal
All boxes must be checked in order to proceed with the surrender form.
Date
MM
DD
YYYY
Name
*
First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Email
*
Dogs Name
Date of birth, if known
MM
DD
YYYY
Breed
Alterations
Color
Is the dog microchipped?
How long have you had the dog?
If you found the dog as a stray, what have you done to find the owner?
Why are you surrendering this dog?
Please provide as much detail and be as open as possible.
Was the dog acquired from a breeder?
Is the dog Spayed or Neutered?
Is the dog AKC registered?
Are the dogs medical records available?
Please contact your vet at the time of completing this form and ask that they send full records to info@dogwooddobermanrescue.org and also have them add a note to your file giving us approval for discussing/accessing the records. This will make it easier for us to take your dog.
Date of last rabies vaccination
Rabies vaccination duration
Date of last Distemper/parvo/combo vaccine given
Type of distemper/parvo vaccine
Date of last Bordatella vaccine
MM
DD
YYYY
Date of last Heartworm test
MM
DD
YYYY
Heartworm test result
Date of last heartworm preventative given
MM
DD
YYYY
Is this dog Von Willebrand’s affected?
Has this dog ever been diagnosed or treated for Wobblers?
Has this dog ever been diagnosed or treated for dilated cardiomyopathy? *
Besides those noted above, list all other medical conditions (allergies, diseases, wounds, breaks, abnormalities, illnesses, surgeries, pregnancies, and indicate all current concerns.
Dog accepts / gets along well with
Please check all boxes where you have personally observed the dog interacting with or getting along with the item/person/animal in the list. Only check boxes where the dog was comfortable and not displaying fear or hesitation around the item/person/animal described.
Dogs social performance
Please check all boxes where you have personally observed the dog interacting in the social situation listed. Only check boxes where the dog was comfortable and not displaying fear or hesitation in the situation described.
Training
Please check boxes where the dog has already been trained (or has received formal training if relevant).
Describe the dog
Describe the dogs behavior, personality, and mannerisms in your own words with as much detail as possible.
Describe the ideal home for this dog and why.
Has the dog ever
Please check boxes where the dog has either attempted or successfully performed any of the behaviors listed.
Has the dog ever bitten
To the best of your knowledge, check any box where the dog has bitten or attempted to bite the animal/person described in the list.
List any other notable behaviors or concerns
Please describe any other behaviors or areas of concern with regard to the dog. Please be as open and descriptive as possible.
