Great Dog Rescue New England Intake Form

Date form filled out:

YYYY

Surrendering Shelter or Rescue:

Where did this dog come from? (shelter pull, local surrender, found as stray)

What date did this dog enter your rescue?

YYYY

Foster Contact - Name, Email & Phone, best times/method to contact

Earliest date Dog will be ready to transport to MA:

YYYY

Dog's Name:

Breed

Gender

Weight

Age

Date of giving birth to pups, if applicable:

YYYY

What is this dog's activity level?

What is the current living situation of the dog? (inside/outside - if in foster care, and where sleeping at night):

Will this dog handle the long transport and 3 days of caged isolation well?

Has this dog ever displayed signs of resource guarding towards humans or other dogs/animals? (growling, snarling or snapping over food, toys, rooms, people, beds/furniture, etc...) If yes, explain.

Has this dog lived with other dogs? How many dogs and what sizes?

Has this dog ever gotten into a tiff, scuffle or fight with another dog? If yes, explain.

Has this dog ever bitten another dog or person, even if by accident? If yes, explain.

Has this dog ever displayed signs of reactive behavior? (barking, lunging, snarling, snapping toward people or other dogs/animals while on walks, from behind a fence, or when new people come into the home or yard) If yes, explain.

Has this dog ever displayed aggressive behavior? (towards men, children, strangers, other dogs) If yes, explain.

Does this dog have experience being leash-walked? If yes, how does she/he handle being leashed?

Does this dog have experience with being crated? If yes, how does she/he handle being crated?

Does this dog have a high prey drive? (chasing wildlife, birds, cats, other dogs) If yes, explain.

Has this dog ever exhibited signs of anxiety? (pacing, howling, humping, licking, barking or crying when left along, submissive, urination cowering, shyness, chewing, other destructive behaviors) If yes, explain.

Is this dog able to greet strangers in a friendly manner? (without barking, lunging, growling, snarling, pulling, snapping or cowering)

Does this dog struggle with mouthy behavior, even if it's just during the day?

When it comes to children this dog ____________. (select an option from the dropdown menu)

Has this dog been exposed to cats?

Yes

Has this dog lived in a house with cats?

Yes

Has this dog had accidents inside the house? If yes, explain.

Does this dog know any obedience training commands? If yes, explain.

Does this dog have any pre-existing medical issues? If yes, explain.

Does this dog have any hair loss or scabby skin areas?

Yes

If yes, dog must receive a negative fungal culture, not a skin scrape. Date of Fungal Culture (if needed)

YYYY

Does this dog have any worn down, cracked, broken, missing, infected or tarter covered teeth? If yes, explain.

Spay/Neuter date (if known):

YYYY

Rabies Vaccine date (if over 12 weeks):

YYYY

DHPP/DHLPP vaccine dates (puppies under 4 months must have at least 3):

4DX test results for dogs over 6 months old - Date and Results

NEGATIVE microfilariae / Knott's Test for heartworm positive dogs - Date and Result:

Bordetella Vaccine Date

YYYY

Albon (10 days prior to transport) or Ponazuril / Marquis (2 days prior to transport) for puppies under 6 months - doses and dates given

Heartworm preventative - type and dates given:

Flea & Tick preventative - type and dates given:

Dewormer - type and dates given:

NEGATIVE fecal test result (required) - date and result:

Please write one or two sentences that best describes what this dog/puppy's best adoptive qualities would be for us to use in our Petfinder listing. This is very helpful to us. Thank you!