Surrender Enquiry Form

- 1 About You
- 2 About Your Dog
- 3 Medical Information
Name & Address
Name

Address

Post Code

Contact Information
Telephone

Mobile

Email Address
- 1 About You
- 2 About Your Dog
- 3 Medical Information
Basic Information
Dog's Name

Breed

Type

Age/D.O.B

Sex

Colour

For what reason would you want us to re-home your dog?

Has the dog ever bitten a person or attacked another animal?

Please give details of any incidents:

Are there any aggression issues that we should be aware of?

Please give details of the issues:

Is the dog food aggressive?

Does the dog guard his possessions or his bed?

Does the dog allow you to remove an object from its mouth?

Does the dog allow you to examine its ears and teeth?

Does the dog allow you to brush him and towel dry him?

Is the dog insured?

Microchip number (if chipped)

Will microchip documentation be handed over?

Photograph

(Only JPG, GIF or PNG files are allowed.)

Home Environment & Training
Is the dog house trained?

How does the dog behave when left alone?

How long is the dog usually left home alone?

Where is it left?

Where does the dog live generally (inside/outside)?

Where does the dog sleep?

Is the dog used to children?

What ages?

Is the dog used to

Cats

Dogs

Birds

Livestock

What is the dog like on the lead?

What type of lead does he have (harness/halti/normal)?

What is the dog like off-lead (will it come back when called?

Is the dog used to being left in kennels?

Does the dog respond to any special commands or to the whistle?

Does the dog travel well in the car?

Has the dog had any previous homes?

If so, why did he leave that home?
- 1 About You
- 2 About Your Dog
- 3 Medical Information
Vaccinations
Is the dog fully vaccinated?

Will vac card be handed over?

Date booster due

Is the dog/bitch fully vaccinated against Kennel Cough?

Neutering
Is the dog/bitch castrated/spayed?

If spayed/castrated - how long ago was this done and for what reason?

If a bitch, when was her last season?

Food
Is the dog overweight?

What food does he/she eat?

How often/how much?

General Health
Does the dog have any obvious lumps/bumps?

Does the dog have any hearing or sight problems?

Is the dog on any medication?

Details of any operations

Date of last worming treatment

Date of last flea treatment

Vet Details
Please ask your vet for your dog’s medical history to bring with you at time of surrender.

Vets Practice Name

Vets Telephone

Are there any medical issues that we should be made aware of?

Please give details of the issues:

Date of last visit

Reason for last visit

The donation given at the time of surrender is used towards Kennel, Vet and re-training costs and will be gratefully received.

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