AWA Canine Client Care Form

Date(Required)

Guardian's Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email Address(Required)

Reason for surrender(Required)

Dog's Name(Required)

Breed(Required)

Weight in pounds(Required)

Age(Required)

Sex / Altered?(Required)

Color(Required)

Has this dog ever bitten or snapped?(Required)

If yes, then please provide details. What were the circumstances of the bite? How severe was the bite? Was skin broken or blood drawn? Have there been multiple incidences of biting? What dates(s) did the bite(s) happen?

What inappropriate or challenging behaviors have you encountered with this dog?(Required)

Be specific about the behavior and frequency of behavior. Challenging behaviors may include: counter-surfing, mouthing, jumping, destructive in home, anxiety.

What, if any medical challenges does this dog have?(Required)

Tell us about the symptoms. How long has the dog been experiencing the issue? When you took the dog to a veterinarian, what diagnosis and treatment did they offer?

Where and when did you get this dog?(Required)

If you did not obtain the dog as a puppy, then please provide as much information as you are aware of the dog's life before you and how many homes the dog has lived in.

How often does this dog meet new people (e.g. daily, once a week, a couple of times a month, etc.)? Where? What is the dog's reaction to new people?(Required)

How does this dog interact with cats?(Required)

Be specific. Does the dog only interact with cats when he sees them while outside on walks? Or does the dog live in the same house with cat(s)? What is the frequency of the interactions? Please detail the cat(s) in the home. What are their names, size, breed, age, altered status (spayed neutered or intact)? How does the dog react to the cat(s)?

How does this dog interact with other dogs?(Required)

Be specific. Does the dog live in the same house with other dog(s)? What is the frequency of the interactions? Please detail the other dog(s). What are their names, size, breed, age, altered status (spayed, neutered or intact)? Has the dog greeted other dogs on leash, or has he played off leash? What's the dog's play style like?

How does the dog interact with children?(Required)

Be specific. Does the dog live in the same house with the child(ren)? What is the frequency of the interactions? What are the children's ages? How does the dog play with children - are they appropriate or does the dog jump up? Are the kids respectful of the dog's space, or do they like to hang all over the dog?

How does the dog behave when left alone?(Required)

How many hours per day is the dog normally left alone?(Required)

Is the dog crate trained (or isolated in a specific location) when alone?(Required)

How do you exercise your dog? What other activities do you do with your dog in and outside of the home?(Required)

Be specific. How frequent is the exercise and activities?

Is this dog house-trained ?(Required)

Does this dog ever have any accidents? How frequent? Where in the house?(Required)

Has this dog ever jumped a fence? How tall(ft.)? Does this dog dig?(Required)

If yes, then please provide additional information. Is the dog supervised or unsupervised when the jumping/digging occurs? How much time does the dog spend in the yard?

What cues do you practice with the dog (include all that apply): SIT, LIE DOWN, STAY, COME, PAW, LEAVE IT, UP, CRATE, WATCH ME, DOWN, ETC.(Required)

Tell us the particulars. How easily did the dog pick up on cues? How receptive was the dog to training? Was training provided in the home, or was a professional trainer or class used? Are the cues verbal or hand signals or both? If you use a similar but different verbal cue to those above, e.g. "WAIT" instead of "STAY" or "BED" instead of "CRATE" or "OFF" instead of "DOWN" then please write as such above.

How does the dog respond to people while eating? How does the dog respond to people while settled down with a bone or a toy? Would you feel comfortable taking away food/bones/toys from the dog?(Required)

Please provide as many specifics as possible regarding these situations and the dog's response.

How do you correct the dog when they are doing something inappropriate?(Required)

Be specific. When is the correction occurring in relation to the inappropriate behavior? What is the dog's response to the correction?

Is this dog afraid of anything? For example - thunderstorms, fireworks, garbage trucks, vacuum cleaners, etc. What is the dog's reaction?(Required)

Please tell us as many details as possible regarding these situations and the dog's response.

Are there any physical abnormalities? Some examples of this may be long claws, missing patches of fur, missing eye, etc.(Required)

Does your dog see a groomer regularly?(Required)

Does your dog have a favorite toy?(Required)

Does your dog have a favorite treat?(Required)

What is the name of your veterinary hospital?(Required)

What is the name of your veterinarian?(Required)

When was the dog's last visit to the veterinarian?(Required)

How does the dog react while at the veterinarian's office?(Required)

Is your companion animal on any monthly heartworm preventatives? These types of preventatives help prevent heartworms and in the form of tablets or chews that are taken orally.(Required)

Yes

If the answer is YES, please specify the last time it was given and how often it has been given. What is/was the brand? This is in an effort to not double dose once they are surrendered to AWA.(Required)

Is your companion animal on any monthly topical preventative? These types of preventatives help prevent fleas, ticks, mosquitoes, etc. They are a form of topical treatment that is usually placed between the shoulder blades in the fur.(Required)

Yes

If the answer is YES, please specify the last time it was given and how often it has been given. This is an effort to not double does once they are surrendered to AWA.(Required)

What brand of food does the dog eat? Is it wet, dry or both? Is the dog used to their food warmed? Where in the house are they fed? How much and how often are they fed?(Required)

If the dog lives in a home with other dogs, where/how is he fed in relation to the other dog?

What would be the perfect home for this dog?(Required)

Additional Notes:

Untitled

First Choice

Second Choice

Third Choice

Untitled

AWA Canine Client Care Form

AWA Canine Client Care Form

About

Pets & Care

Get Involved

Adopt

Clinic

About Us

Programs

Education

Events

Support AWA

Volunteer

Adopt

Clinic

About Us

Programs

Education

Events

Support AWA

Volunteer