Intake Form – Pacific Northwest Cattle Dog Rescue

Dog's Name: *

Dog's Location: *

First

Middle

Last

Age or DOB: *

Weight: *

Breed(s): *

Does the dog have a microchip? *

Yes
No
Unsure

Microchip #:

What is your relationship to the dog? *

Why is the dog being rehomed? *

By what date does the dog need to be rehomed? *

How long have you had the dog? *

Where did you get the dog? *

What the dog's typical reaction to a new person? *

Does the dog tend to be WORSE with certain groups of people? (men, women, kids, strangers, neighbors, vet) *

Has the dog lived with kids? If so, what ages? *

How does the dog react when approached by a small child? *

How is the dog around kids who are running, playing or yelling? *

Has the dog ever nipped or bit a person? *

When did the most recent snap, nip or bite occur? Please describe all occurances.

What has been the highest level bite? *

Canine Bite Levels:

CLICK TO VIEW

Has a bite required medical attention or been reported to authorities? *

Yes
No
Unsure

Has the dog been around other dogs in the past 6 months? *

What's the dog's typical reaction when meeting new dogs? *

How would you describe your dog's playstyle when they are comfortable with another dog? *

What is the dog's typical reaction to cat, rabbits or other small animals? *

What is the dog's typical reaction to chickens, ducks or other farms birds? *

What is the dog's typical reaction to horses, cattle or other livestock? *

Has the dog ever fought, killed or injured another dog or animal? *

If so, please describe the incident:

Date of most recent incident:

What does the dog do if another dog comes near their water bowl? *

... food bowl? *

... toys? *

... crate? *

What does the dog do if a person reaches for their water bowl? *

... food bowl? *

... toy? *

What does the dog do if a person reaches in their crate? *

What does the dog do if disturbed while sleeping or resting? *

How does the dog react to getting brushed? *

How does the dog react to getting bathed? *

How does the dog react to having feet wiped or handled? *

How does the dog react to getting nails trimmed? *

When does the dog need a muzzle? *

Does the dog have accidents in the house? *

How does the dog let you know that they need to go to the bathroom? *

How many hours is the dog typically left alone during the day? *

... indoors free-run (without people)? *

... indoors free-run (with people)? *

... indoors in a crate? *

... outdoors in yard (without people)? *

... outdoors in yard (with people)? *

... outdoors on tie-out? *

... outdoors in kennel? *

... at dog park? *

... at doggie daycare? *

... with dog walker? *

... in training? *

... on-leash walk? *

... off-leash walk? *

How does the dog walk on-leash? *

What equipment is the dog used to? *

Has the dog ever jumped a fence? *

Yes
No
Unknown

If yes, what fence height? How recently?

Has the dog ever dug under a fence? *

Yes
No
Unknown

Has the dog had training? *

Trainer:

First

Last

First

Middle

Last

Is the dog food-motivated? *

Yes, will work for treats
Sometimes, easily distracted
No, won't work for treats
Sometimes, easily stressed

Does the dog came to their name when off-leash in an unfenced environment (like a beach or park)? *

Yes, reliably
Sometimes, not reliably
No, not reliably

The dog will chase: *

The dog will bite: *

The dog enjoys: *

What does the dog typically do when left alone indoors (free-run of home)? *

... when left alone indoors (in crate)? *

... when left alone outdoors (in yard)? *

... when left alone outdoors (in kennel)? *

What's the dog's energy level? *

Low — calm; not interested in sustained vigorous play
Medium — enjoys socializing, chase or tug; can calm down naturally
High — very engaged with person; constantly bringing toys; never seems to tire

Does your dog have seperation anxiety?

None — rests quietly when crated or alone in home/vehicle; may whine or bark at first but quiets quickly
Mild — needs chew toy or other distraction in order to rest when crated or alone in home/vehicle; may whine or bark with or without distraction
Moderate — doesn’t rest when crated or alone in home/vehicle even with distractions; may injure themselves or damage property when alone; barks; whines
Severe — attempts to escape when crated or alone in home/vehicle; injures themselves; damages property; barks or whines without stopping

How does your dog behave in the car? Check all that apply. *

Is the dog crated trained? *

Yes
Yes, but out of practice
No
Unknown

As an adult dog, have they chewed or damaged anything other than dog toys? *

Have they been a service dog? *

Yes
No
Unknown

Have they been a working dog? *

Yes
No
Unknown

Most Recent Veterinary Exam: *

Veterinarian: *

First

Last

Name *

First

Middle

Last

Does PNWCDR have permission to contact your veterinarian? *

Yes
No
Unsure

Can PNWCDR be provided with proof of spay/neuter? *

Yes
No
Unsure

Can PNWCDR be provided with rabies certificate? *

Yes
No
Unsure

Rabies Vaccine: *

Distemper Vaccine: *

Flea Preventative: *

First

Last

Tick Preventative: *

First

Last

Heartworm Preventative: *

First

Last

Does the dog have any unresolved or chronic medical conditions? *

Does the dog have any previous injuries, surgeries or illness that we should be aware of? *

Has the dog exhibited any of the following symptoms in the past fourteen (14) days? Check all that apply. *

"I would keep this dog if I could change ..." *

Has a courtesy listing request been submitted for this dog? *

Yes
No
Unsure

https://pnwcdr.org/courtesy-listings

Date *

The following form provides us with information about your dog. This information will help us find a suitable foster home and adopter. Your thorough answers will ensure a successful future for your dog.

The following form provides us with information about your dog. This information will help us find a suitable foster home and adopter. Your thorough answers will ensure a successful future for your dog.