Rehoming Your Dog Questionnaire

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

YOUR DOG'S DETAILS

Name of your dog*:

Sex*:

Date of Birth, if known:

Age*: years months

Microchipped*: If yes give the microchip no:

Breed*:
If Other give details:
Colour/Description*: Size*:

Previous Homes:
Where did your dog originally come from*:

How many previous homes has your dog had*:
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):

REASONS FOR REHOMING

Why do you need to rehome your dog*:

Are you rehoming your dog due to behavioural issues*:
If 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*:
If yes give details:

Have you had your dog assessed by a qualified animal behaviourist/trainer*:
If yes give details:

Do you have a training/management plan in place*:
If yes attach a copy (File types: pdf or jpg - Size: less than 1MB):

Have you taken any other steps*: If yes give details:

MEDICAL DETAILS

Is your dog neutered*: If yes give date:

Do you have an unspayed bitch*:
If yes when did she last start: and/or finish her season:

If female has she had any litters*: If yes give date(s):

Vaccinated*:
If yes enter date: Against:

Wormed*:
If yes enter date: and Product Used:

Deflead*:
If yes enter date: and Product Used:

Allergies*: If yes give details, including medication:

Epileptic Fits*: If yes give details, including medication:

Heart Problems*: If yes give details, including medication:

Any other ongoing health problems*:
If yes give details, including medication:

Any operations, other than neutering*:
If yes give details including dates:

Which Veterinary Practice is your dog registered*:

Can we have a copy of your dog's veterinary history*:
Please note this is required for all animals that we take in for rehoming, to ensure we are meeting their needs.

DIETARY DETAILS

What food do you give your dog?

Describe food types, quantity and times feed*:

Is your dog used to treats*:
If yes give details:

Are there any dietary restrictions that apply*:
If yes give details:

BEHAVIOUR/TEMPERAMENT/WELLBEING

Describe the temperament of your dog*:

Are there any known factors/events that may have an impact on your dogs behaviour*:
If yes give details:

Has your dog ever Bitten*:
If 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*: If yes give full details:

Is there anything your dog can be anxious/scared of*:
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*:
If 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:

HOME ENVIRONMENT

Would you describe your home environment as quiet, normal or busy*:

Who currently lives in the home with your dog:
No. of Adults*: No. of children*:
If 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*:
If no give details:

Used to or lived with cats*:
If yes give breed, sex, neutering status:

Used to or lived with other dogs*:
If yes give breed, sex, neutering status:

Used to or lived with other pets*:
If 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*:
If no give details:

Visiting children*: 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*:
If yes what steps have you taken to manage them:

Where does your dog sleep*:

Is your dog allowed on the furniture*: If yes give details:

Does your dog have full access to your home:
When you are in*: If no give details:
When you are out*: If no give details:

Has your dog been teased by children*: If yes what ages: Less than 112345678910111213141516 years old (Select all that are applicable)

Does your dog live on a Quiet or Busy Road*:

Does your dog live in a Country, Suburban or Urban area*:

Does your dog have access to a secure garden*:

Height of fence/wall: Minimum*: Maximum*:

Has your dog ever tried/managed to escape from the home or garden*:
If yes give details:

OUTSIDE OF THE HOME

How much exercise is your dog given or needs*:

Does your dog interact well with other animals (including livestock/wildlife, if known)*:
If no give details of the circumstances and steps taken:

Good recall*: 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)*: If yes give details:

Have you taken your dog on holiday with you*:
If yes give details of the experience:

Has your dog ever been in kennels*:
If yes what feedback have you received about your dog's experience in the kennels:

NEW HOME

What do you feel your dog needs from a new home:

Would your dog benefit/be okay in a family home with children*:
If yes how young a child could they live with: years old

Would your dog benefit/be okay in a home with other pets*:
If 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*:

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*:
If yes please explain:

ADDITIONAL COMMENTS

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:

OWNER'S CONTACT DETAILS






Are you the owner or owner's representative*:

REPRESENTATIVE'S CONTACT DETAILS







What is the reason for completing this questionnaire on behalf of the owner*:

Do you have the owner's permission*: - Can you/we obtain signed confirmation*:

REPLY DETAILS


SUBMIT FORM


* = required field

This form complies with our Privacy Policy under the Data Protection Act

Web form last revised 13th December 2018