EmailMe Form - Rescue Resumé

Today's Date *

MM / DD / YYYY

This form does NOT constitute a reassignment of ownership *

I understand

Primary contact *

First Last

Primary's phone number *

### - ### - ####

Primary's alternate phone number

### - ### - ####

(if applicable)

Primary's Email *

Secondary contact

First Last

Secondary contacts phone number

### - ### - ####

Address where the dog is living *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Dog's Name *

Nicknames

Gender *

Date of birth *

Breed(s) *

Did you acquire this dog from a reputable breeder with whom you have a signed contract? *

***Have you contacted your breeder about taking the dog back?

***Breeder details (any you may have available)

We will not make contact until/unless we have first spoken with you

Did you adopt this dog from Oregon Weimaraner Rescue? *

Approximately when?

What # owner are you? *

Vet info *

Clinic name
Phone number
Address

The most recent vet to have seen your dog (put n/a if necessary)

Current weight? *

lbs

Spayed / neutered? *

Ever had puppies? *

Current on rabies vaccine? *

Current on DA2PP vaccine? *

(or variation thereof)

Currently on a monthly heartworm preventative? *

Brand

Does your dog have any current or ongoing health problems? *

Please list/explain

Is your dog currently on any medications? *

Please list/explain

Is your dog allergic to anything including food(s)? *

Please list/explain

Is your dog licensed? *

AKC registered? *

***AKC papers in your possession? *

Is your dog microchipped? *

***Microchip number

Your Dog's Behaviors

Please give us an honest appraisal of your dog so that we may make informed decisions related to placement needs

Does your dog chew inappropriate items (shoes, rocks, clothing, furniture, etc)? *

Details

Does your dog bark uncontrollably when left alone? *

Details

Does your dog have separation anxiety? *

Details

Is your dog crate trained? *

Crate info

Type of crate (wire/plastic)?
Length of time typically crated

Details

When it comes to food, does your dog: *

Details

Can you put your hand in your dog's bowl while they are eating? *

Details

Dog on human bite experience. Select the highest level ever experienced after age 6 months. *

--Dr. Ian Dunbar’s Dog Bite Scale--

Level 1. Obnoxious or aggressive behavior but no skin-contact by teeth.

Level 2. Skin-contact by teeth but no skin-puncture. However, may be skin nicks (less than one tenth of an inch deep) and slight bleeding caused by forward or lateral movement of teeth against skin, but no vertical punctures.

Level 3. One to four punctures from a single bite with no puncture deeper than half the length of the dog’s canine teeth. Maybe lacerations in a single direction, caused by victim pulling hand away, owner pulling dog away, or gravity (little dog jumps, bites and drops to floor).

Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dog’s canine teeth. May also have deep bruising around the wound (dog held on for N seconds and bore down) or lacerations in both directions (dog held on and shook its head from side to side).

Level 5. Multiple-bite incident with at least two Level 4 bites or multiple-attack incident with at least one Level 4 bite in each.

*****Levels 1 and 2 comprise well over 99% of dog incidents. The dog is certainly not dangerous and more likely to be fearful, rambunctious, or out of control*****

https://apdt.com/wp-content/uploads/2017/01/ian-dunbar-dog-bite-scale.pdf

Please explain

This dog HAS been the subject of a bite investigation conducted by an animal control agency *

a response of "true" does not mean we will not assist you

Details

Does your dog jump fences? *

How high?

Does your dog dig? *

Details

Do you take your dog to dog parks or dog daycare? *

Details

Is your dog good with small dogs such as Chihuahuas? *

Details

Is your dog good with medium to large dogs? *

Details

Is your dog good with cats? *

Details

Is your dog good with small animals such as squirrels, hamsters or guinea pigs? *

Details

Is your dog okay around farm animals (chickens, goats, rabbits, horses, cows, etc)? *

Details

Does your dog like to ride in the car? *

Details

Does your dog chase people on bicycles or skateboards? *

Details

What ages of people is your dog suited to be around? *

Newborn to 4 years old

5 to 10 years old

11 to 17 years old

18+

Select all that apply

How do you know this? *

Does your dog prefer one human gender over another? *

Details

Please Answer the Following Questions

What is your dog afraid of (vacuum, gun fire, fireworks, thunder, big dogs, hats, vets, etc.)? *

Where does your dog sleep at night? *

Is your dog ever allowed to free roam the house while you are gone? *

Details

Is your dog allowed on furniture? *

Where does your dog stay while you are at work? *

Where does your dog stay when you are gone for a day or two? *

(or does your dog always come with)

Feeding *

What brand of food do you feed your dog?
What flavor?
Amount per feeding?
How many times per day?
What time(s) of day do you feed?

What commands does your dog respond to? *

My dog is:
(check all that apply)

Details

Is there any other information which you feel is pertinent to your dog or situation?

I agree to the full release of all veterinary records to Oregon Weimaraner Rescue, or an agent thereof, relating to the above named dog *

I accept

By submitting this form you agree and understand that Oregon Weimaraner Rescue, its agents, volunteers or representatives may make contact with you to collect follow up details or provide information related to our organization. *

I understand

Photo upload(s)

I certify that all information provided in this document is truthful and accurate to the best of my knowledge *

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