Date:________________ Process #:______________ 

Why are you dropping off the animal?_________________________________
Who has been your veterinarian for this pet?________________________
How long have you had this pet?_____________________________________
What vaccinations has your pet had?_________________________________
When are these vaccinations again due?______________________________
Is your pet spayed/neutered? __ yes __ no
If this pet is a dog what heartworm preventative do you use?
__ daily (Filaribits) __ monthly (Interceptor or Heartguard)
If monthly, when is the next dosage due?____________________________
Did your pet live with children?____________________________________
If so, what ages?_____________________________________________
Was the pet kept indoors?___outdoors?____ fenced yard?___kept chained?___
 

 Comments:______________________________________________________________
_______________________________________________________________________ 

If this pet is a dog what percent level of obedience would you say your
pet is at?
__ Less than 50% of the time 
__ More than 50% of the time
__ Always
__ Never

Obeys the following commands: __Come __sit __No __Stay __Down __Heel

Is the dog 100% housebroken? __yes __No. If no, please explain:________

How does the dog indicate a need to go out?____________________________

Check any behavior your dog exhibits: 
  __Urinates in the house __Defecates in the house __Chew __Digs __Bites 
  __Fights with other pets __Jumps on people __Has car sickness __Jumps 
  or climbs fences __Other 

If you are giving your pet up because of what you believe is an irreversible
discipline problem, please indicate which obedience school you attended so 
that we, or the new owner, can contact the trainer on any specific problems:
______________________________________________________ 

If this pet is a cat is the cat 100% litter box trained? __yes __No.
If no please explain:_________________________________

Check the behavior your cat exhibits? __Urinates in the house
 __Defecates in the house __Chews __Bites __Fights with other pets 
 __Scratches furniture __Scratches People __Sprays __Has car sickness __Other

Feeding: What is your pet's feeding schedule?
 __Free Access __Set Time (when)__________

What type of food (brand) is your pet accustomed to eating?____________________

Grooming: Does your pet enjoy baths and grooming?__yes __No

How often is your pet groomed?___________________________________________

Please make any other comments on your pet's behavior or temperament that
would help us find a suitable home! _____________________________________
_________________________________________________________________________
 Please print this form and bring it when you come in.

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