Animal Services Pet Retention Program Survey

Animal Services Pet Retention Program Survey

Contact Information

First Name*

Last Name*

Email*

Phone*

Phone

Address*

About your Pet

Pet’s Name*

Photo of Pet

If you have a photo of your pet, please upload one here.

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Breed*

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Other Breed - Please Specify

Age*

Sex of pet*

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Is your pet spayed/neutered?*

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Is your pet vaccinated?*

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Pet History - General

How long have you had your dog?*

Where did you get your dog?*

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Where did you get your dog? - Other

Pet History - Health

Does your dog have any medical or health concerns?*

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Please briefly describe your dog's medical or health concerns.

How much exercise is your dog getting daily?*

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Behavior - Socialization & Compatibility

Has your dog lived with men?*

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Has your dog lived with women?

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Has your dog lived with children?*

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What is the age range of children that your dog has lived with?

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Does your dog live with other animals?*

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How does your dog do around other dogs?*

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Please briefly explain your dog's behavior around other dogs.

How does your dog do around cats?*

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How does your dog do around strangers?

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Behavior & Training - General

Does your dog exhibit any of the following behavioral issues?*

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Please briefly explain your dog's resource guarding behavior.

Behavioral Issues - Other

How long has your dog displayed any of these behaviors?*

Is your pet potty-trained?*

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Is your pet crate-trained?*

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How does your dog do when left alone?

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How is your dog on leash?*

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Please briefly explain what your dog is reactive to while on leash.

Does your dog have a bite history?*

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Has your dog ever attacked another dog? Cat? Other animal? If yes, please explain.

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Attack history details

Please briefly describe any history of attacks on other animals.

Have you consulted a veterinarian about any issues? Behavioral or otherwise?*

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Please briefly explain your experience with the veterinarian consultation.

Have you consulted/or worked with a professional trainer?*

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Please briefly explain your experiences with a professional trainer.

Resources and Re-homing

Why are you unable to keep your dog?*

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Why are you unable to keep your dog? - Other

What resources would you need to be able to keep your dog?*

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Extra Resources - Other

Have you reached out to friends, family members etc…to try and re-home your dog?*

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Any other information that you believe would be helpful to know about your pet?

How were you referred to the program?

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