Blue Chip Farm Animal Refuge
Phone: 570-333-5265
Email: emmaripka6899@gmail.com

SURRENDER


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Your Personal Information

DOG'S BASIC INFORMATION

WE WILL NEED ACCESS TO YOUR VETERINARIAN'S INFORMATION TO CONTACT THEM IN ORDER TO CONFIRM MEDICAL STATUS. PLEASE GIVE YOUR VETERINARIAN'S OFFICE PERMISSION TO RELEASE INFORMATION TO OUR SHELTER WHEN WE MAKE THE CONTACT.
THIS INCLUDES ANY DIAGNOSIS BY THE VET (EPILEPSY, FOOD ALLERGY, NEEDED MEDICATIONS, ETC.), PLEASE INCLUDE AS MUCH INFORMATION AS POSSIBLE.
PLEASE EXPLAIN REASON AS IN DEPTH AS POSSIBLE.
Exact or best estimate

BEHAVIORAL QUESTIONS

IN DEPTH PLEASE

PERSONALITY/TEMPERAMENT

ADDITIONAL INFORMATION


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