Owned Dog Intake Profile Owned Dog Profile Form OWNED DOG INFORMATION PROFILE This form is designed to help determine what will be in the best interest of your dog and to assist our staff in understanding your dog more. To help us learn more about your dog, please fill out this form completely. Please understand that the dog's welfare must and will always be our foremost consideration. Therefore, the Humane Society will not release information on this dog after it has been released to us. OWNER'S INFORMATIONFirst Name* Last Name* Email* Phone Number* Owner's Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code DOG'S GENERAL INFORMATIONDog's Name* Dog's Breed(s)* Dog's Weight* Dog's Age* Is your dog’s age an estimated age?* Yes No Gender of dog* Female Male Is your dog fixed?* Yes No I Don't Know DOG'S GENERAL HISTORYWhere did you get your dog?*How long have you owned your dog?*Why are you needing to give your dog up?*Is there anything that would enable you to keep your dog? If yes, please tell us what.*Has your dog lived with (Check all that apply):Adult MenAdult WomenTeenagersChildrenToddlersBabiesDoes your dog get along with everyone in your household? Please explain.Has your dog lived with other dogs? Yes No If yes, how many other dogs? Did they get along? Please describe their interactions.Has your dog lived with cats? Yes No If yes, how many cats? Did they get along? Please describe their interactions.ENVIRONMENT AND PERSONALITYWhere does your dog spend most of his/her day? (inside, outside, in a room, in a fenced yard, in a run, in a crate, etc.)Does your dog spend time outdoors? Yes No When indoors, where does your dog spend most of his/her time?How long is your dog left alone without people on an average day? What is your typical routine of activities with your dog each day?What type of food do you feed your dog and how often is he/she fed? Is food available all the time or at set "mealtimes"?What are your dog’s favorite foods?Have you taken your dog to a training class? If so, where?Do you train your dog at home? If so, how? (with treats, clicker training, a particular type of collar?)What does he/she know how to do (such as sit, come, down, stay, walk nicely on a leash, shake hands, etc.)Do you walk your dog? If so what type of collar or harness does your dog wear for walks?If not, why? Any problems with walking your dog? If so, please describe.What other types of exercise besides walking does your dog get? How often?How would you describe your dog’s personality?In general, does your dog like to be petted?YesNoSometimesWhere and how does your dog like to be petted?Where and how does your dog NOT like to be petted?Does your dog like to be picked up? Yes No N/A (my dog is too big to be picked up) Does your dog get on the furniture? Yes No Does your dog like to sit on your lap? Yes No Does your dog like to play? Yes No If yes, please describe how/what he likes to play.Does your dog like to play with toys? What type?Does your dog chew on chew toys? If yes, what kind?Where does your dog usually sleep at night? Has your dog ever shown any growling, barking, snarling or mouthing/biting towards you or anyone else? If so, when?How does your dog respond to visitors? People - Adults? Children? Other dogs - Dogs he knows? Dogs he does not know?What do you like best about your dog?What are your dog’s favorite things?What is your dog afraid of? Are there things your dog does not like or is afraid of? If so, please describe.Does your dog have any bad habits (such as barking, digging, jumping up, escaping, chasing, stealing off counters, chewing things up, etc.)? If yes, please describe his/her bad habits. When does he/she bark, when and what does he/she steal, when and what does he/she destroy, who or what does he/she chase, etc.?How have you addressed these and did you find anything that helped?HOUSE TRAINING HISTORYHow would you describe your dog’s house training?Great, not having any accidentsOK, only rare accidents (less than once a month)Could be better, a few accidents each weekAwful -accidents nearly every dayHow long has this problem been going on? How have you tried to address this problem? Did anything you have tried help? HISTORY OF MEDICAL ISSUESDoes your dog see a veterinarian? If yes, who?How does your dog behave during veterinary visits?Does your dog have any past or present medical problems? If yes, please describe.Is your dog on any medications? If yes, please describe.Has your dog shown any of these signs:CoughingSneezingItchingDiarrheaVomitingLack of AppetiteNone of the AbovePlease select all that applyAny change in grooming or sleeping habits?Any change in water or food consumption?Any change in frequency of urination or defecation?