Dog's Details
Dog’s Name
Dog’s Breed
Dog's Current Age
Age of dog when you acquired him/her?
Colour
When did you acquire your dog?
From where did you acquire your dog?
If from a breeder, you are required to give breeder details:
If from a rescue, give the details of the rescue:
Microchip Number
Are you the registered owner of the dog?
Owner's Details
Owner Name
Address
Contact Number
Email
Date (YYYY-MM-DD)
Do you have children at home? (if yes, please include ages)
Do you have children who visit? (if yes, please include ages and frequency of visits)
Do you have other dogs (please give ages and breed)
Is your dog registered with a Vet?
Please give Vet’s Name, address and contact details
When was the last time your dog visited the Vet?
For what reason?
Feeding Information
What do you feed your dog?
How many times per day do you feed your dog?
Do your give your dog treats?
What are his/her favourite treats?
Is your dog a good eater or picky?
Does changing his/her food affect behaviour?
Medical
Is your dog on any medications (either long or short term)?
Please give condition being treated
Please detail any previous medical conditions or surgeries
Have you had to consult the Vet regarding any behavioural issue?
If Yes, please give details
When was your dog last:
Vaccinated:
Flea Treated:
Wormed:
When was your dog last in season (if a bitch) - Please state when the season ended
Daily Routine
How long is your dog typically left alone on a weekday / weekend?
Does he/she settle when left alone?
Where in the household does he/she stay when left alone?
Where does he/she sleep at night?
Does he/she ever wake you at night?
Does he/she have access to toys (please detail)?
Is there access to a garden & at what times?
Where does your dog tend to go to the toilet?
Does he/she spot-mark with small amounts of urine?
Does he/she tend to follow any particular person around the house?
Is your dog crate trained?
Is your dog muzzle trained?
Exercise
What activities do you provide your dog?
How often do you carry out these activities?
How would you describe your dog’s energy levels?
Low
Normal
Over Excitable
Hyper
Behaviour
Please indicate your dog’s behaviour with the following:
Basic Commands:
Commands under distraction:
Recall:
Jumping up:
Chewing:
Mouthing:
Pulling on leash:
Toileting/Toilet trained:
Fear:
Anxiety:
Separation Anxiety:
Socialisation (people):
Socialisation (dogs):
Resource Guarding:
Behaviour around small animals (cats, rabbits etc):
Does your dog like to be cuddled?
Do they like to sit on the furniture?
Do they like being groomed?
What is your dog like during vet visits, traffic, loud noises?
Has your dog ever been to day care or had an employed dog walker?
If yes, how was his/her behaviour?
Has your dog ever bitten or caused injury to a person?
If yes, please give details:
Has your dog ever bitten another dog or been involved in a dog fight?
If yes, please give details:
Please describe your dog’s reaction in the following situations:
In the presence of a human:
Petting while eating:
Handling food while eating:
Petting while chewing on a chew:
Taking a chew away:
Petting while chewing/playing with toy:
Taking away a toy:
Petting while drinking:
In the presence of another Dog:
Approaching your dog while eating:
Approaching while drinking:
Approaching while chewing /Playing with a toy:
How does your dog react in the following situations with PEOPLE?
When someone enters the home:
With people in the home:
In the garden:
On the leash:
Off the leash:
Other:
How often does your dog do the following?
Jumps on people while greeting:
Jumps on people in the home:
Jumps on people in the garden:
Barks in the home:
Barks in the garden:
Barks on walks:
Escapes barriers (ie fences, gates, crate etc):
How often does your dog have accidents in the house?
Does your dog mouth/play bite with you?
If yes, is this a wanted or unwanted behaviour? Please explain:
How do you discipline your dog?
Has there been any changes in yours and/or your dog’s circumstances recently or any traumatic events? If yes, please give details:
Has your dog had any previous training?
If yes, please give details of type of training and where:
Would you consider your dog to have manners?
What is the reason you are rehoming your dog?
Owner Declaration
By signing this document you agree that you have provided St Francis Dogs Home a true and
accurate account of the dog you are wishing to rehome.
Print Name:
Date:
Send
