Dog Intake QuestionnaireWe understand that the decision to surrender a pet is not easy. We do our best to help every person that comes to us. Sometimes, there are better re-homing options, and we may recommend other resources, depending on your pet’s needs. Here is a link to other organizations in the area. We are a private, non-profit, no-kill shelter with a 98% live release rate. We operate on an appointment-based schedule, and are usually scheduling 1-2 weeks in advance. If you need immediate assistance, we recommend contacting your municipal shelter. If you are returning a pet within 2 weeks of adoption, we can usually offer an appointment within 48 hours of receiving this form. We have a few questions that will help us assist you and your pet. Please be as detailed as possible when answering. Once we have received your questionnaire we will be in touch (usually by phone) to get more information and discuss next steps. Date* Date Format: MM slash DD slash YYYY Your Name* First Last Preferred namePronounshe/him, she/her, they/them, etcAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email Is it okay to send a detailed email to this address?*YesNoPhone*Is it okay to leave a detailed message at this number?*YesNoAre you the owner of this dog?*YesNoPlease provide full name and contact information of the ownerGeneral InformationWhy are you surrendering your dog?*What efforts have you taken to re-home your dog?*What is your timeline for surrendering*Less than 1 week1-2 weeks2 weeks - 1 monthGreater than 1 monthSeattle Humane is usually scheduling 1-2 weeks in advance. If you need immediate assistance, please contact your municipal shelter. Dog's Name*Age*please include units - i.e. yearsBreed(s)*Color(s)*Size*Small (0-25 pounds)Medium (25-50 pounds)Large (50-75 pounds)Extra-Large (75-100 pounds)Sex*MaleFemaleUnsureSpayed or neutered?*YesNoUnsureIs your dog microchipped?*YesNoUnsureMicrochip number if knownHistoryHow long have you had your dog?*Please include units - i.e. yearsWhere did you get your dog?*Ex: friend, craigslist, stray, breeder, pet store, etcHas your dog seen a veterinarian?*YesNoUnsureName of Vet or ClinicWe will contact your vet to obtain medical records. This helps us triage incoming animals and have a thorough picture of how to best serve you and your pet.Phone Number of Vet or ClinicDoes your dog have any current medical conditions or illness?*YesNoUnsurePlease explain any medical conditionsHas your dog ever growled, lunged at, or barked at:* Strangers in the home Strangers outside the home Children he/she knows Unfamiliar children Dogs he/she knows Unfamiliar dogs Cats he/she knows Unfamiliar cats Other None Select all that applyIf other, please explainHow is your dog around unfamiliar people?*How is your dog around unfamiliar dogs?*Has your dog ever snapped at or bitten a person?*YesNoPlease select yes if your dog has done this, even if they didn't break skinHas your dog ever snapped at, fought with, or bitten another animal?*YesNoPlease select yes if your dog has done this, even if they didn't break skinDoes your dog growl, lunge, snap, or bite when you attempt to take away toys, food, treats, or other items the dog values?*YesNoUnsureWhen leaving or left alone, does your dog pace, bark, cry, whine, pant, bite or chew doors/windows/furniture, or show other anxiety related behaviors?*YesNoUnsureWhat does your dog do when left alone? Are they confined?*Optional: Add a photo of your pet This iframe contains the logic required to handle Ajax powered Gravity Forms.