Owner Surrender Intake Questionnaire

Name of Setter

Age of Setter

Gender

Approximately how much does the dog weigh?

How long have your owned the dog?

Where did you acquire the dog?

Where is the dog located?

Describe how the dog gets along with other dogs?

Has the dog been around cats?

If yes, please describe the interaction.

Has the dog been around children of any age, young or older?

If yes, please describe how they act around either age group.

Is the dog housetrained?

Is the dog crate trained?

Is the dog leash trained?

Do you have a fenced yard?

If yes, please describe the fence, including the height.

Has the dog ever jumped the fence?

Has the dog ever bitten anyone?

If yes, please describe.

Name of dog food currently being used

Is the dog spayed/neutered?

Is the dog up to date on vaccinations, including rabies?

Has the dog been on monthly heartworm preventative?

Has the dog been heartworm tested recently?

Is the dog microchipped?

If Yes, enter microchip number, if known.

List any known medical issues

List all medications this dog is currently taking.

List any known behavioral issues or sensitivities we should know about.

Please share any additional information about the dog’s health or temperament.

Why are you seeking help from rescue for the dog?

How long are you able to keep your dog before rehoming?

Have you reached out to any other Rescue? If so, which one(s)?

What is the best method to contact you?

Please upload a few pictures of your dog.

Picture # 2