Owner Assistance Form
What state do you live in?
Your form will automatically be sent to the designated person for your state.
Phone number that is best to reach you:
Full Street Address (where the dog is located):
City, State, Zip
Mailing Address (if different):
Are you the legal owner of the dog?
Was this dog found as a stray?
If yes, do your best to answer the remainder of the questions. You may leave questions blank if not applicable.
Where and when was he found?
BASIC DOG INFO
Dog's Age: (Birthdate if known)
How long have you had the dog?
Is he/she a purebred Springer Spaniel or a mix?
Is he/she AKC registered?
Where did you get the dog?
For example, if from a breeder, what name and town? Was he/she from a shelter?
If from a breeder, have you contacted the breeder?
Why are you rehoming your dog?
How would you describe your dog?
What does he/she like or enjoy? What does he/she dislike?
Where does the dog currently stay and sleep?
Inside? Outside? If inside, does he/she have full range of the home or just part?
How active is the dog?
(i.e. low key, moderate, energetic, hyper)
What type of activity or exercise does he/she get?
(Describe how and where, such as leash walks, playing in the yard, dog park.)
KNOWN BEHAVIORS AND CONDITIONS
Please be honest with us! We are here to help and full of compassion for our favorite breed.
Is the dog house-trained?
Is the dog crate trained?
In the past, but not now
Has problems with crating
Does he/she ride well in the car?
Is he/she good with grooming?
Is he/she good at the vet?
Does he/she have any separation anxiety (problems when you leave him/her alone)?
How does the dog behave on a leash?
Does the dog have any behaviors that you wish he/she didn't have (such as jumping, digging, chewing, fear of thunderstorms)?
How does the dog behave with other dogs?
How does the dog behave with cats?
How does the dog behave with children? What ages has he/she been around?
What commands does the dog know? Did he he/she ever go to an obedience class or was it learned at home?
Any dominance or submissive behavior with people?
How does your dog behave with new people in the home?
Barks briefly, but quickly stops and is friendly
Cautious or reserved
Assertively barks and challenges strangers
Growling is a form of communication for dogs. For some dogs, that threshold is set quite high, such as he/she would only guard a piece of delicious steak, but others may growl and guard their food and toys. Some dogs take that up a notch and possibly bite a stranger. Does your dog growl to communicate about anything? Does he/she guard anything? Has your dog ever shown any aggressive behaviors?
If so, please describe. Is it with other dogs or people?
What does your dog do if you try to take food away?
Allows food to be removed
What does your dog do if you try to take a favorite toy away?
Doesn't play with toys
Gives up toy if you take it
Drops toy for you
Has he/she ever bitten anyone? If so, please describe.
Any other behavior comments?
Does your dog go to the vet on a regular basis?
Approximate month and year of last vet visit.
Are his/her shots up to date?
Yes, up to date
No, not up to date
When was the last Heartworm test and what were results?
Is he/she on regular preventative heartworm medicine? If yes, what brand, strength, and what day of the month?
Is he/she on flea/tick medicine? If yes, what brand, and when was the last dose?
Vet Practice Name, City, and Phone number
Vet Practice fax number and email, if available.
Does he/she have any current or recurrent health conditions, such as ear infections, skin problems, or medications used (other than preventative.) Describe any conditions.
What food is he/she on? How much does he/she get and what times?
Does the dog have a microchip?
Any other health or vet comments:
To your knowledge, is there any type of person or household with whom we should NOT place your pet?
What type of home would your dog thrive in best?
Is there anything else you would like to share?
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