Please be as accurate and informative as possible.
If you are rehoming more than one dog please fill out a separate form for each dog.
* = required field
Name of your dog*:
Sex*: ---MaleFemale
Date of Birth, if known:
Age*: ---0123456789101112131415161718192021222324252627282930 years ---01234567891011 months
Microchipped*: ---YesNo If yes give the microchip no:
Breed*: ---AffenpinscherAfghan HoundAiredale TerrierAkitaAlaskan MalamuteAnatolian Shepherd DogAustralian Cattle DogAustralian ShepherdAustralian Silky TerrierAustralian TerrierAzawakhBarbetBasenjiBasset Bleu De GascogneBasset Fauve De BretagneBasset Griffon Vendeen (Grand)Basset Griffon Vendeen (Petit)Basset HoundBavarian Mountain HoundBeagleBeauceronBedlington TerrierBelgian Shepherd Dog (Groenendael)Belgian Shepherd Dog (Laekenois)Belgian Shepherd Dog (Malinois)Belgian Shepherd Dog (Tervueren)BergamascoBernese Mountain DogBichon FriseBloodhoundBologneseBorder TerrierBorzoiBoston TerrierBouvier Des FlandresBoxerBracco ItalianoBraque D'AuvergneBriardBrittanyBull TerrierBull Terrier (Miniature)Bulldog (British, English)Bulldog (American)BullmastiffCairn TerrierCanaan DogCanadian Eskimo DogCatalan SheepdogCavalier King Charles SpanielCesky TerrierChihuahua (Long Coat)Chihuahua (Smooth Coat)Chinese CrestedChow ChowCirneco Dell'EtnaCollie (Bearded)Collie (Border)Collie (Rough)Collie (Smooth)Coton De TulearDachshund (Long Haired)Dachshund (Miniature Long Haired)Dachshund (Miniature Smooth Haired)Dachshund (Miniature Wire Haired)Dachshund (Smooth Haired)Dachshund (Wire Haired)DalmatianDandie Dinmont TerrierDeerhoundDobermannDogue de BordeauxEnglish SetterEnglish Toy Terrier (Black & Tan)Entlebucher Mountain DogEstrela Mountain DogEurasierFinnish LapphundFinnish SpitzFox Terrier (Smooth)Fox Terrier (Wire)FoxhoundFrench BulldogGerman Longhaired PointerGerman PinscherGerman Shepherd DogGerman Shorthaired PointerGerman Spitz (Klein)German Spitz (Mittel)German Wirehaired PointerGlen Of Imaal TerrierGordon SetterGrand Bleu De GascogneGreat DaneGreat Swiss Mountain DogGreenland DogGreyhoundGriffon BruxelloisGriffon Fauve De BretagneHamiltonstovareHavaneseHovawartHungarian KuvaszHungarian PuliHungarian PumiHungarian VizslaHungarian Wire Haired VizslaIbizan HoundIrish Red & White SetterIrish SetterIrish TerrierIrish WolfhoundItalian GreyhoundItalian SpinoneJack Russell TerrierJapanese Akita InuJapanese ChinJapanese Shiba InuJapanese SpitzKeeshondKerry Blue TerrierKomondorKooikerhondjeKorean JindoKorthals GriffonLagotto RomagnoloLakeland TerrierLancashire HeelerLeonbergerLhasa ApsoLowchen (Little Lion Dog)MalteseManchester TerrierMaremma SheepdogMastiffMiniature PinscherMiniature SchnauzerMunsterlander (Large)Munsterlander (Small)Neapolitan MastiffNewfoundlandNorfolk TerrierNorwegian BuhundNorwegian ElkhoundNorwich TerrierOld English SheepdogOtterhoundPapillonParson Russell TerrierPekingesePharaoh HoundPicardy SheepdogPointerPolish Lowland SheepdogPomeranianPoodle (Miniature)Poodle (Standard)Poodle (Toy)Portuguese PodengoPortuguese PointerPortuguese Water DogPugPyrenean MastiffPyrenean Mountain DogPyrenean Sheepdog (Long Haired)Retriever (Chesapeake Bay)Retriever (Curly Coated)Retriever (Flat Coated)Retriever (Golden)Retriever (Labrador)Retriever (Nova Scotia Duck Tolling)Rhodesian RidgebackRottweilerRussian Black TerrierRussian ToySalukiSamoyedSchipperkeSchnauzer (Giant)Schnauzer (Miniature)Schnauzer (Standard)Scottish TerrierSealyham TerrierSegugio ItalianoShar PeiShetland SheepdogShih TzuSiberian HuskySkye TerrierSloughiSlovakian Rough Haired PointerSpaniel (American Cocker)Spaniel (American Water)Spaniel (Cavalier King Charles)Spaniel (Clumber)Spaniel (Cocker)Spaniel (English Springer)Spaniel (Field)Spaniel (Irish Water)Spaniel (King Charles)Spaniel (Sussex)Spaniel (Welsh Springer)Spanish Water DogSt. BernardStaffordshire Bull TerrierSwedish LapphundSwedish VallhundTibetan MastiffTibetan SpanielTibetan TerrierTurkish Kangal DogWeimaranerWelsh Corgi (Cardigan)Welsh Corgi (Pembroke)Welsh TerrierWest Highland White TerrierWheaten Terrier (Soft Coated)WhippetWhite Swiss Shepherd DogXoloitzcuintle (Mex Hairless) IntXoloitzcuintle (Mex Hairless) MinXoloitzcuintle (Mex Hairless) StdYorkshire TerrierOTHERIf Other give details: Colour/Description*: Size*: ---Toy (up to 4kg)Small (3-16kg)Medium (16-30kg)Large (25-39kg)Giant (34-55kg+)
Previous Homes: Where did your dog originally come from*:
How many previous homes has your dog had*: ---None12345+What reasons has your dog been rehomed in the past:
If have a picture or video of your dog please attach a copy (File types: jpg or mp4 - Size: less than 5MB):
Why do you need to rehome your dog*:
Are you rehoming your dog due to behavioural issues*: ---YesNoIf yes describe in full the circumstances leading up to any events/incidents and how they have been managed:
Have you had your dog checked over by a Vet to see if there are any underlying health problems that would cause a change in behaviour*: ---YesNoIf yes give details:
Have you had your dog assessed by a qualified animal behaviourist/trainer*: ---YesNoIf yes give details:
Do you have a training/management plan in place*: ---YesNoIf yes attach a copy (File types: pdf or jpg - Size: less than 1MB):
Have you taken any other steps*: ---YesNo If yes give details:
Is your dog neutered*: ---YesNo If yes give date:
Do you have an unspayed bitch*: ---YesNoIf yes when did she last start: and/or finish her season:
If female has she had any litters*: ---None12345+ If yes give date(s):
Vaccinated*: ---YesNoIf yes enter date: Against:
Wormed*: ---YesNoIf yes enter date: and Product Used:
Deflead*: ---YesNoIf yes enter date: and Product Used:
Allergies*: ---YesNo If yes give details, including medication:
Epileptic Fits*: ---YesNo If yes give details, including medication:
Heart Problems*: ---YesNo If yes give details, including medication:
Any other ongoing health problems*: ---YesNoIf yes give details, including medication:
Any operations, other than neutering*: ---YesNoIf yes give details including dates:
Which Veterinary Practice is your dog registered*:
Can we have a copy of your dog's veterinary history*: ---YesNoPlease note this is required for all animals that we take in for rehoming, to ensure we are meeting their needs.
What food do you give your dog?
Describe food types, quantity and times feed*:
Is your dog used to treats*: ---YesNoIf yes give details:
Are there any dietary restrictions that apply*: ---YesNoIf yes give details:
Describe the temperament of your dog*:
Are there any known factors/events that may have an impact on your dogs behaviour*: ---YesNoIf yes give details:
Has your dog ever Bitten*: ---YesNoIf yes give a full description of any incidents, including events leading up to, any injuries that occurred and how the incident was managed/concluded:
Any guarding issues*: ---YesNo If yes give full details:
Is there anything your dog can be anxious/scared of*: ---YesNo If yes give details and describe any steps taken to lessen/manage any anxieties:
How does your dog behave when attending a veterinary surgery*:
Does your dog have any problems being handled anywhere on its body*: ---YesNoIf yes give details:
Does your dog need any regular Grooming, Bathing or Nails Clipped:GroomingBathingNails Clipped (Select all that are applicable)If yes how does your dog respond to it:
Would you describe your home environment as quiet, normal or busy*: ---QuietNormalBusy
Who currently lives in the home with your dog:No. of Adults*: ---123456789 No. of children*: ---None123456789If children what ages: Less than 112345678910111213141516 years old (Select all that are applicable)
Does your dog get on/interact well with and respond to everyone in the home*: ---YesNoIf no give details:
Used to or lived with cats*: ---YesNoIf yes give breed, sex, neutering status:
Used to or lived with other dogs*: ---YesNoIf yes give breed, sex, neutering status:
Used to or lived with other pets*: ---YesNoIf yes give species, breed, sex, neutering status:
How does your dog interact with other animals in your home:
Visitors:How does your dog behave when the postman arrives*: Does your dog get on/interact well with visitors to the home*: ---YesNoIf no give details: Visiting children*: ---YesNo If yes what ages: Less than 112345678910111213141516 years old (Select all that are applicable)
How long is your dog used to being left alone*: Are there any behavioural problems/anxieties when left alone*: ---YesNoIf yes what steps have you taken to manage them:
Where does your dog sleep*:
Is your dog allowed on the furniture*: ---YesNo If yes give details:
Does your dog have full access to your home:When you are in*: ---YesNo If no give details: When you are out*: ---YesNo If no give details:
Has your dog been teased by children*: ---YesNo If yes what ages: Less than 112345678910111213141516 years old (Select all that are applicable)
Does your dog live on a Quiet or Busy Road*: ---Quiet RoadIntermediate RoadBusy Road
Does your dog live in a Country, Suburban or Urban area*: ---Country AreaSuburban AreaUrban Area
Does your dog have access to a secure garden*: ---YesNo
Height of fence/wall: Minimum*: ---0.9m (3ft)1.2m (4ft)1.5m (5ft)1.8m (6ft)2.1m (7ft)2.4m (8ft) Maximum*: ---0.9m (3ft)1.2m (4ft)1.5m (5ft)1.8m (6ft)2.1m (7ft)2.4m (8ft)
Has your dog ever tried/managed to escape from the home or garden*: ---YesNoIf yes give details:
How much exercise is your dog given or needs*:
Does your dog interact well with other animals (including livestock/wildlife, if known)*: ---YesNoIf no give details of the circumstances and steps taken:
Good recall*: ---YesNo If no give details:
Behaviour whilst travelling*:
Is your dog sociable when out and about (Example: Are you able to take them to dog friendly cafes, parks, pubs, shops)*: ---YesNo If yes give details:
Have you taken your dog on holiday with you*: ---YesNoIf yes give details of the experience:
Has your dog ever been in kennels*: ---YesNoIf yes what feedback have you received about your dog's experience in the kennels:
What do you feel your dog needs from a new home:
Would your dog benefit/be okay in a family home with children*: ---YesNoIf yes how young a child could they live with: ---Less than 112345678910111213141516 years old
Would your dog benefit/be okay in a home with other pets*: ---YesNoIf yes what type of pet(s):
Do you feel your dog would be okay in a busy family home, or a more quiet/calm home environment*: ---Busy Family HomeQuiet/Calm Home
How much company does your dog need*:
Is there anything else you can think of that your dog would need from a new home, please describe*:
If rehoming more than one pet would they need to be homed together*: ---YesNoNot ApplicableIf yes please explain:
Please add any other comments you feel are not covered by this questionnaire, the more information we have, the better we can help find the right home for your dog's needs:
Are you the owner or owner's representative*: ---OwnerRepresentative
If you are completing this questionnaire on behalf of the owner, please complete the following:
What is the reason for completing this questionnaire on behalf of the owner*:
Do you have the owner's permission*: ---YesNo - Can you/we obtain signed confirmation*: ---YesNo
This form complies with our Privacy Policy under the Data Protection Act
Web form last revised 13th December 2018