Name *

First

Last

Phone *

Email *

Dog Location *

Please give an address

Do you *

Own the animal
Someone else’s/Stray

If not yours, please explain:

Was this animal

Adopted through HSUV
Adopted through another shelter
Bought/Given privately
Other

Why are you needing to rehome the animal?

Pet Name *

Age

Breed

Gender

Male
Female

Spayed/Neutered?

Yes
No
Unknown

Microchipped

Yes
No
Unknown

Up to date on vaccinations?

Yes
No
Unknown

When and where were the vaccines administered?

Which vaccines were administered?

Has the animal been seen by a vet clinic? Do we have permission to get medical history?

Please list vet clinic’s name and phone number

How long have you owned this pet?

Does well with

Other dogs
Cats
Kids

Does NOT do well with

Other dogs
Cats
Kids

If so, please explain reaction

Is the animal

Indoor
Outdoor
Both

Is the animal potty trained/ houstrained?

Yes
No

Is this dog kennel trained

Yes
No
Unknown

Any behavioral issues? If yes, please explain…

(excessive barking, destructive, shy, separation anxiety, escape artist, etc…)

Have they ever bitten anyone? If so what were the circumstances?

Please explain any medical issues or concerns

Sick, pregnant, injured, nursing, etc.

Would you be open to owner fostering until adoption?

Yes
No

How soon do you need to have the dog placed?

Please describe the dog's appearance and personality

I acknowledge that filling out this form doesn't mean HSUV can take the animal but is to help HSUV determine if there is a foster home fitting for the animals needs. I understand that it may take time for HSUV to find a foster and sometimes no foster will become available, but HSUV's animal coordinator will be in touch as soon as possible.

I Understand

E Signature *

First

Last

Date

DOG INTAKE FORM

IF MORE THAN ONE ANIMAL NEEDING REHOMED,
PLEASE FILL OUT A FORM FOR EACH ANIMAL

After submitting the form, please email us a photo of the animal
at hsuvdogs@hsuv.org

DOG INTAKE FORM

IF MORE THAN ONE ANIMAL NEEDING REHOMED,PLEASE FILL OUT A FORM FOR EACH ANIMALAfter submitting the form, please email us a photo of the animal at hsuvdogs@hsuv.org

IF MORE THAN ONE ANIMAL NEEDING REHOMED,
PLEASE FILL OUT A FORM FOR EACH ANIMAL

After submitting the form, please email us a photo of the animal
at hsuvdogs@hsuv.org