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Your details
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Title
First name
Last name
Phone number
*
What days are you available for us to call you?
*
Our dog behaviour team will phone you from a private number to discuss your dog and arrange a surrender appointment time. Please select all days that work for you.
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Email address
*
Current address
*
Street
Suburb
Postcode
Which RSPCA South Australia shelter is closest to you?
*
Please select one
RSPCA Lonsdale
RSPCA Port Lincoln
RSPCA Whyalla
Your dog's details
If you wish to surrender more than one animal, please fill out one form per animal.
Dog's name
*
Age
*
Breed
*
Gender
*
Please select one
Female
Male
Is your dog desexed?
*
Please select one
Yes
No
Unsure
Is your dog microchipped?
*
Please select one
Yes
No
Unsure
If yes, what is the microchip number?
Is your dog registered with a council?
*
Please select one
Yes
No
Unsure
If yes, which council?
Where did you get your dog from?
*
How old was your dog when you acquired him/her?
*
Are you surrendering your dog because you can't afford vet treatment?
*
Please select one
Yes
No
If no, why are you surrendering your dog?
If yes, can you explain what the vet issues are?
Lifestyle and home life
Is your dog allowed inside?
*
Please select one
Yes
No
Sometimes
Is your dog allowed outside?
*
Please select one
Yes
No
Sometimes
Where does your dog prefer to spend most of its time?
*
Please select one
Indoors
Outdoors
Has your dog ever escaped or tried to escape?
*
Please select one
Yes
No
If yes, how long ago did the escaping attempts start?
The moment escaping starts can often relate to a time of change in your dog's life, which is important information for our behaviourists.
If yes, how did your dog escape or try to escape?
Please select all that apply.
Jumped fence
Climbed fence
Dug under fence
Other
If yes, how often has your dog escaped or tried to escape?
Please select all that apply.
Several times a week
Once a week
Several times a month
Other
How high are your fences and what are they made of?
Please select all that apply.
4 feet
6 feet
Higher than 6 feet
Chain mesh or wire
Colourbond
Brick
Where is your dog kept when no one is home?
*
What does your dog do as you leave the house?
*
What does your dog do when left home alone?
*
What does your dog do when you return home?
*
Where does your dog sleep at night?
*
How much time does your dog spend on his/her own?
*
Does your dog follow you from room to room when you are home?
*
Please select one
Yes
No
Sometimes
Do you have any other dogs?
*
Please select one
Yes
No
Do you have any cats?
*
Please select one
Yes
No
Do you have any other pets?
*
Please select one
Yes
No
If yes, what other pets do you have?
How does your dog interact with these other pets?
Which pet arrived in your house first?
Social interactions
How would you describe your household?
*
Please select one
Quiet
Busy
In between
How many adults live in your household?
*
Please enter a number from
0
to
15
.
Do children live in your household?
*
Please select one
Yes
No
If yes, what are the children's ages?
Do any of the children play with dog?
Please select one
Yes
No
If yes, does the dog:
Tolerate them
Ignore them
Walk away
Hide from them
Does the dog need to be taught to be gentler when he/she plays with children?
Please select one
Yes
No
How often does the dog require 'time out' from the children?
Has your dog met:
Select all that apply.
Many children?
Many adults?
Many other dogs?
Many other animals?
Please describe any unpleasant situations involving children, adults, or other animals
How does your dog react when people or strangers come to the house?
*
Please select one
Excited/playful
Ignores them
Growls/barks
Hides
How long does it take him/her to calm down?
*
Does your dog have access to visitors?
*
Please select one
Yes
No
Do you need to restrain him/her, or is he/she free to interact?
*
Please select one
Restrained
Free
Is your dog happy to be touched and handled by visitors and strangers?
*
Please select one
Yes
No
If no, how does your dog react?
Are there any parts of his/her body that your dog doesn’t like being touched by visitors/strangers (eg: paws, head)?
*
When INSIDE the home, how does your dog react to unfamiliar men?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When OUTSIDE the home, how does your dog react to unfamiliar men?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When INSIDE the home, how does your dog react to unfamiliar women?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When OUTSIDE the home, how does your dog react to unfamiliar women?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When INSIDE the home, how does your dog react to younger children?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When OUTSIDE the home, how does your dog react to younger children?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When INSIDE the home, how does your dog react to older children?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When OUTSIDE the home, how does your dog react to older children?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When INSIDE the home, how does your dog react to other dogs?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When OUTSIDE the home, how does your dog react to other dogs?
*
Friendly
Barks at them
Growls
Snaps at them
Avoids them
Not interested
Hides
When INSIDE the home, how does your dog react to cats?
Friendly
Not interested
Avoids
Hides
When OUTSIDE the home, how does your dog react to cats?
Friendly
Not interested
Avoids
Hides
Behaviour and temperament
How active is your dog?
*
Please select one
Very
Moderately
Not Very
Unsure
How playful is your dog?
*
Please select one
Very
Moderately
Not Very
Unsure
How affectionate is your dog?
*
Please select one
Very
Moderately
Not Very
Unsure
Does your dog like to hunt or chase prey?
*
Please select one
A lot
Sometimes
No
Unsure
Does your dog like to be patted and touched?
*
Please select one
A lot
Sometimes
No
Unsure
Is your dog outgoing and interactive or shy and likes to be left alone?
*
Please select one
Outgoing and interactive
Shy and likes to be left alone
Does your dog enjoy being picked up and handled?
*
Please select one
A lot
Sometimes
No
Unsure
Has your dog ever scratched anyone (even if while playing or scared)?
*
Please select one
Yes
No
If yes, please give us more details:
Has your dog ever bitten anyone (even while playing)?
*
Please select one
Yes
No
If yes, what happened?
Has your dog ever been in a fight with another dog?
*
Please select one
Yes
No
If yes, what was the fight over? How old was your dog at the time?
Has your dog ever needed to be muzzled for any reason?
*
Please select one
Yes
No
If yes, under what circumstances?
Does your dog travel well?
*
Please select one
Yes
No
Does your dog vocalise excessively?
*
Please select one
Yes
No
If yes, when and why? Have the neighbours ever complained?
Is there anything that may cause your dog to be nervous or fearful?
*
Please select one
Yes
No
If yes, what specifically?
Storms
Fireworks
Loud noises
Camera flashes
Other dogs
Other animals
How does your dog react?
Food and feeding
What do you feed your dog?
*
How many times a day is your dog fed?
*
At what time of day is your dog fed?
*
Is your dog comfortable with people being around when he/she is fed?
*
Please select one
Yes
No
If no, what does the dog do in this situation?
Is your dog comfortable with other animals being around when he/she is fed?
*
Please select one
Yes
No
If no, what does the dog do in this situation?
Can you easily take food, bones or toys from your dog?
*
Please select one
Yes
No
Never tried
If no, what is your dog's reaction when you try to take such items?
Training
Has your dog attended training or puppy classes?
*
Please select one
Yes
No
If yes, what classes? How long ago? Where? What methods were used? (For example, treat training, check chain.)
What cues and commands does your dog respond to?
Sit
Stay
Does your dog come when called?
*
Please select one
Yes
No
Sometimes
How well does your dog walk when on a leash?
*
Please select one
Walks well
Pulls sometimes
Not well - pulls constantly
Won't walk
Do you use any walking equipment?
*
Please select one
Head halter
Body harness
Choker
Flat collar
None
Does your dog enjoy being picked up and handled?
*
Please select one
A lot
Sometimes
No
Unsure
Health and vaccinations
Has your dog ever had any vaccinations?
*
Please select one
Yes
No
Unsure
If yes, approximately when was the last vaccination?
Can you provide a vaccination certificate to RSPCA?
Please select one
Yes
No
Please upload a copy of your dog's most recent vaccination certificate.
This document is crucial in helping us determine whether or not your dog might need quarantining.
Drop files here or
What is the name of your current vet?
First name
Last name
What are the contact details for your current vet?
How does your dog behave at the vet?
When was the last time you took your dog to the vet?
*
Does your dog have any medical conditions/history that you are aware of?
*
Please include visits to the vet for dog fights, illnesses and accidents.
Yes
No
If yes, please provide full details:
Is your dog currently on any medication, including heartworm preventative?
*
Yes
No
If yes, please provide full details:
Exercise and play
How often is your dog walked?
*
Please select one
Daily
Weekly
Monthly
Never
How long does each walk generally last?
*
Where do you take your dog when you walk him/her?
*
Describe your dog's reaction when he/she sees another dog:
*
Do you regularly exercise your dog off-leash?
*
Please select one
Yes
No
Do you let your dog sniff and play with other dogs (outside the home)?
*
Please select one
Yes
No
Does your dog have a best friend or doggy playmate?
*
Please select one
Yes
No
If yes, please provide details of the playmate (lives in same household? breed, sex, age etc.):
What are your dog’s favourite games to play?
What are your dog’s favourite kinds of toys?
Is your dog rough and/or mouthy during play?
*
Please select one
Yes
No
If yes, please describe:
Grooming
How often do you bath your dog?
*
Please select one
Daily
Weekly
Monthly
Never
How often do you brush your dog?
*
Please select one
Daily
Weekly
Monthly
Never
How does your dog behave when groomed?
Please select one
Enjoys
Compliant
Fearful
Fusses but can control
Panics and cannot control
Becomes aggressive
Never tried
Has your dog ever been professionally groomed?
*
Please select one
Yes
No
Can you easily trim your dog's claws?
*
Please select one
Yes
No
Never tried
Final details
List three words that would describe your dog?
For example: loner, affectionate, demanding, playful, food motivated, etc.
List three things that make your dog happy:
What sort of home and family do you believe would suit your dog?
*
Are there any quirks or habits that you are not fond of in your dog?
Is there anything else you would like to tell us about your dog?
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