NEW HOPE VIZSLA RESCUE

Date: ______

INTAKE FORM PREPARED BY:______

Owner Information

Name
Address
Citv/State/Zip
Phonenumbers)
Email
Dog Information
Dog's Name
Dateobtained / Age obtained and age now.
Where obtained?
From whom? / Name / Describe process in finding this breeder.
Sex / Male
Female / Neutered orspayed? When?
Does the doglive? / Indoors
Outdoors
Housebroken / Crate trained
Travels well in cars
Used tokennel
Is the dog? / Shy Quiet
Friendly Obedient
Playful Nervous
Active Outgoing
Protective / Has this dog ever bittenanyone. Please describe.
Is the doggood with? / Men
Women
Children
- - under5
- -(5-12)
- - teenagers
Other dogs
Cats
Other smallanimals / Describe.
Is the dogafraid of? / Strangers
Storms
Guns
Vacuums
Other / Discuss fears
Frequent behaviors? / Chewing
Digging
Barking/howling
Chasing cars/bikes
Jumping on people
Escaping
Other / Describe behaviors.
Obedience training?
This may be formal or training that owner provided / Yes - at what age\
No / Where was training taken?
Commands known
Does the dog have
favorite toys or games? / Yes
No / Describe
What is the normal
exercise pattern for this
dog / Daily walk
Free run in fenced yard
Free run - open land
Hours per day in crate / Other. Very important, please describe.
Does the dog have natural
hunting ability, or do you
hunt with the dog? / Yes
No / Describe behaviors.
What kind of food docs
the dog eat? / Dry
Canned
Table food
Other
Supplements given / Describe. What brands of food eaten
Is the dog on medication? / Heartworm preventive
Thyroid
Antibiotics
Cortisone
Flea/tick treatments
Seizure meds
Other / Please describe.
Please provide Veterinarian name and contact information:
How would you describe the generaltemperament
of your dog?
What kind of family do you think wouldbest fit
your dog's needs?
Why are you placing your dog in rescue?