Nevada SPCA

Basic Information

The dog's name is *

Why are you giving the dog up? *

Where did you get the dog? *

How old is the dog? *

How long have you had the dog? *

What breed is your dog? *

Gender*

Male

Female

Is the dog neutered?

Yes

I don't know

Is the dog spayed?

Yes

I don't know

Where does the dog spend the day?

Inside

Outside

Both

If the dog sleeps inside, where do they sleep?

Dog Bed

Furniture

Your Bed

Other

Is the dog house-trained?

Yes

If house-trained, how often does the dog need to go out?

If your dog has accidents, is it only when left alone?

Yes

Medical Information

Does your dog have a microchip?

Yes

Your dog's vet clinic information *

Please provide: Name of the clinic, address, and phone number.

Does your dog have any medical conditions?*

Yes

What medical conditions do they have?

Is your dog on any medications?*

Yes

What are they?

Is your dog current on vaccinations?*

Yes

Personality Questionnaire

What is your dog afraid of?

Where is your dog sensitive about being handled? (eg. ears, feet)

Does your dog destroy things in the house or yard?

Yes

What items?

How often?

Has your dog ever lived with children?

Yes

If he has ever lived with children, what ages?

Is your dog good with those children (friendly, tolerant)?

Yes

If your dog is not good with children, please explain.

How often do they interact?

Behavioral Information

What does your dog do if:

a child is crying/screaming?

a child touches or pets them?

they sees a child on a bike?

they see a child running?

Has your dog ever growled at you or anyone else?

Yes

Explain the growling

Has your dog ever snapped at you or anyone else?

Yes

Explain the snapping

Has your dog ever bitten (broken skin) you or anyone else?

Yes

Explain the biting

What other animals has your dog lived with?

Dogs

Cats

Other

How does your animal do with the other dog(s)?

How does your dog do with the house cat(s)?

How does your dog do with the other animal(s)?

How does your dog react when they see an outdoor cat?

How does your dog react when they see a small animal like a squirrel?

How does your dog react when they see another dog outside?

When seeing another dog, is their behavior different with a leash?

How does your dog act at the dog park?

Has your dog ever fought with another dog?

Yes

Has your dog ever injured another dog?

Yes

What does your do do when:

A stranger/visitor knocks on the door?

A stranger/visitor comes into the house?

A stranger approaches you on a walk?

You or someone else goes near the food bowl when they are eating?

You or someone else tries to take away toys or a dog treat?

You or someone else gives them a hug?

You or someone else reprimands them?

Have you or has someone else trained them?

Yes

Have you or has someone else ever taken your dog to a training class?

Yes

What is your dog's favorite game or toy?

What is your dog's best quality?

What is your dog's worst quality?

Is there anything else we should know about your dog?

Owner Information

Name

First Name *

Last Name *

Address

Address 1 *

Address 2

City *

ZIP / Postal Code *

State / Province *

Email Address *

Phone Number *

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