DESCRIBE ANY INJURIES OR KNOWN HEALTH PROBLEMS AND LIST ANY CURRENT MEDICATIONS INCLUDING HEARTWORM PREVENTATIVE.
(If you can't provide vet or requested health information, please explain why here.)
VET'S PHONE NUMBER
ARE YOU THE OWNER? *
IF NO, DO YOU HAVE THE AUTHORITY TO ACT AS AGENT FOR THE OWNER?
HOW LONG HAVE YOU OWNED THE DOG?
WHERE DID YOU GET THE DOG?
IF THE DOG WAS BOUGHT FROM A BREEDER, PLEASE GIVE BREEDER'S NAME AND LOCATION IF KNOWN
IS THE DOG REGISTERED (I.E DOES IT HAVE "PAPERS"?
HAS THIS DOG EVER SHOWN AGGRESSION TOWARD PEOPLE INCLUDING BUT NOT LIMITED TO AN INJURY BITE (ONE THAT LEFT BRUISED OR BROKEN SKIN)? IF YES, PLEASE EXPLAIN.
HAS THIS DOG EVER SHOWN AGRESSION TOWARD OTHER DOG(S)?
IF YES, PLEASE EXPLAIN.
IS THE DOG USED TO A CRATE?
WHAT ARE THE DOG'S FAVORITE ACTIVITIES/TOYS?
NOTE: ALTHOUGH NOT REQUIRED, A SURRENDER DONATION WOULD BE GREATLY APPRECIATED.
I CERTIFY THAT THE INFORMATION GIVEN ABOVE IS TRUE AND COMPLETE TO BEST OF MY ABILITY.
IF YOU LEAVE THIS PAGE BEFORE CLICKING SUBMIT, YOUR DATA WILL BE LOST.
WHEN YOU HAVE COMPLETED THIS FORM, CLICK THE SUBMIT BUTTON BELOW AND THE DATA WILL BE SAVED AND TRANSMITTED TO NEW SPIRIT RESCUE.
THANK YOU FOR YOUR INTEREST IN NEW SPIRIT AUSSIE RESCUE. SOMEONE WILL CONTACT YOU SOON.