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Dog Surrender Profile

  General Information:

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Name:

 

 
   

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City/State/ZIP:

 

    

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Date of Birth:

 

 

An appointment is requested so we're better prepared for your animal's arrival. To schedule a surrender appointment, please complete this form and call the campus nearest you:

  • Milwaukee Campus: 414-431-6102
  • Racine Campus: 262-554-6699
  • Ozaukee Campus: 262-377-7580
  • Green Bay Campus: 920-469-3111
  • Door County Campus: 920-746-1111
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Question - Required - How would you describe your dog?

 

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Question - Required - Where do you keep your dog when you have to leave the house?

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Question - Required - Where do you keep your dog when you are home?

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When outside unsupervised did your dog:
 


 


 


 


 


 


 


   


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Please select the definition that best describes your dog in the following circumstances.

Very Excited - your dog will bark, whine and jump up on people and objects. Your dog seeks out activity and will chase people or things. Your dog has a hard time calming down and usually has to be removed from whatever is causing the excitement.

Excited - your dog will bark and whine and may jump up on people or objects, but calms within a short time. 

Happy - your dog is interested, but very polite. Your dog does not jump up, but will wag his or her tail and approach. 

Indifferent - your dog is not interested and does not break away from whatever he or she may be doing. 

Anxious - your dog appears to be excited and will approach. Ears are down and its tail will be tucked but wagging. Your dog has a very guilty look. Your dog gets so excited or anxious it pees.

Scared - your dog runs away from the situation and attempts to hide under or behind a table or other object. Your dog may eventually approach depending on the circumstances.

Growls - your dog growls in a low tone and may assume a stiff body posture.

Shows Teeth - the lips curl back so that the front teeth can be seen.

Snaps - your dog attempts to bite, but does not bite hard or break the skin.

Nips - your dog bites but does not bite hard enough to break the skin.

Bites - your dog bites, breaks the skin or tears clothing.

Barks - your dog is very vocal.

Don't know - I am not familiar with how my dog will react.

Other - Please explain in the space provided

How does your dog react when:
 


 


 


 


 


 


 


 


 


 


 

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Please mark the cues your dog knows:
 


 


 


 


 


 


 

Would you say taht most of the time your dog is:
 


 


 


 


 


 


 


 


 


 


 


 


 


 


 


 

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Is your dog afraid of:
 


 


 


 


 


 


 


 


 


 


 


 


 

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