Dog Intake Form - San Francisco SPCA

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Dog History Form (Intake)

This form is for clients who wish to return an animal adopted from the SF SPCA

"*" indicates required fields

Guardian Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Dog's Name*

How long have you had your dog?*

Less than 30 days

More than 30 days

Dog's Sex*

Male

Female

Is your dog spayed/neutered?*

Yes

No

Why are you giving up your dog?*

Moving

Allergies

Not housetrained

New baby

Too much energy

No time

Not getting along with other pets

Not getting along with family members

Behavior issues

Other

Please elaborate on your dog not getting along with other pets:*

Please elaborate on your dog not getting along with family members:*

Please elaborate on your dog's behavior issues:*

Please elaborate on any other reason why you are giving up your dog:*

How did you obtain this dog?*

SF SPCA Adoption

Newspaper/Internet

Found stray

Friend

Breeder

Gift

Other Shelter/Rescue

What shelter/rescue did you obtain this dog from?*

How was your dog raised?*

With children

Inside only

Outside only

Both indoor and outdoor

Single pet

With other pet(s)

What pet(s) was your dog raised with?*

Where is the dog kept at the home?

When you are at home?*

Inside

Outside

Goes in & out

When you are away from home?*

Inside

Outside

Goes in & out

How many hours is your dog left alone on an average day?*

Please enter a number from 1 to 24.

When the dog is inside he/she is:*

Roaming freely

Kept in a room

In a crate

Other

Please explain other:*

When outside, how is the dog confined?*

Fenced yard

Fenced dog run (size)

Electric fence

Tethered by chain or cable

Garage

No confinement

When alone, how does he/she behave?*

Rests

Plays

Paces

Chews

Whines

Howls

Digs

Tries to escape

Barks

Other

Please explain other:*

When alone, has the arrangement above been successful?*

Yes

No

If no, please explain:*

Where does the dog sleep?*

Inside

Outside

Where does the dog sleep inside?*

Where does the dog sleep outside?*

Housetraining Information

Is this dog housetrained?*

Yes

No

Does this dog have accidents?*

Yes

No

What kind of accidents?*

Urine

Feces

Both

When does this dog have accidents?*

Frequent accidents, even when people are home

Only has accidents when left alone over a certain period of time

Only has occasional accidents

How much time can this dog be left alone for before an accident occurs?*

Please explain this dog's occasional accidents:*

Where does this dog go to the bathroom?*

Yard

Walks

Newspaper/potty pads

Litterbox

Other

If other, please explain:*

Is your dog crate-trained?

Yes

No

When is the dog in its crate?*

What is the maximum amount of time the dog stays in the crate?*

What type of crate?*

Wire

Plastic

Does the dog have accidents in the crate?*

Yes

No

Other

Please explain other:*

Feeding Information

What type of food does this dog eat?*

Dry kibble only

Canned food only

Dry & canned

Special diet

What brand of kibble?*

What brand of canned food?*

Please explain the dog's special diet:*

How often / how much does this dog eat?*

1x day

2x day

Free fed

How much does this dog eat once a day?*

How much does this dog eat twice a day?*

How much does this dog eat in a day?*

Does this dog have any favorite treats?*

Training Information

Which commands are this dog familiar with?*

Please check all that apply:

Sit

Down

Stay

Come

Heel

Shake

Other

Please explain other:*

Leash walking behavior:*

Pulls on leash

Walks politely on leash

No exposure to leash

What training equipment is this dog used to?

Harness

Gentle leader

Choke chain

Pinch/prong collar

Other

Please explain other:*

Has this dog had obedience training?*

Yes

No

What type of training?*

How do you discipline the dog?*

Verbal correction

Physical correction

Other

Please explain other:*

How does he/she respond to this discipline?*

Exercise Information

Does this dog get exercise/play time with you?*

Yes

No

How often?*

Daily

Few times per week

Once a week

Once a month

Less than once a month/rarely

How long does your dog exercise?*

15 minutes

1/2 hour

1 hour

Other

Where does your dog get its exercise?*

Yard only

Leashed walks

Dog park

Off-leash play

Other

Please explain other:*

Does your dog play with other dogs?*

Yes

No

Does your dog play with a resident dog and/or other dogs at dog parks?*

Resident dog

Dog park

Does your dog like playing with dogs outside of the home?

Yes

No

Resident dog only

Behavior Information

Does your dog have any behavior issues that a new adopter should be aware of?*

Barking

Nipping

Needy

Destructive behavior

Jumping on people

Aggressive towards people outside of home

Aggressive towards other dogs OFF leash

Aggressive towards other dogs ON leash

Aggressive towards visitors to home

Aggressive towards other animals

What kind of animals is your dog aggressive towards?*

Is your dog scared of:*

Men

Women

Children

Strangers

Vet

Groomer

Riding in the car

Loud noises

Thunder

Fireworks

Bathing

Brushing

Nail clipping

Other animals

Other

What other animals is your dog afraid of?*

Please explain other:*

When walking on leash, does your dog bark at:*

Dogs

Cats

Jogger

Bicycle

Motorcycle

Skateboard

People

Other

Please explain other:*

Does your dog bite or growl when you touch his food, treats, or toys?*

Yes

No

If yes, explain:*

How would you characterize this dog overall?*

Please check all that apply:

Calm

Excitable

Hyper

Cuddly

Confident

Friendly

Outgoing

Stubborn

Smart

Shy

Fearful

Nervous

Dependent

Independent

Happy

Clingy

Protective of family

Protective of home

Easy going

Veterinarian Information

Name of Veterinarian or Clinic:

Date of last visit:

Current on vaccinations?

Yes

No

In the last 30 days has your dog had:*

Coughing

Sneezing

Vomiting

Diarrhea

None

In the last 30 days has your dog been to a boarding facility or doggy day care:*

Yes

No

Other information

Please add any additional information that you feel would be helpful for us, or a new owner. This will help us make the best possible match with a new home.

Upload Files

Upload Medical Records & Photo

Drop files here or

Max. file size: 50 MB.

Please upload any digital copies of medical records below. If you are unable to upload directly, please bring any physical copies to your surrender appointment.

53989

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