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Pre-Surrender Form
Home
Surrender
Pre-Surrender Form
Owner Information
Name(s)
*
Phone #
Street Address
Email
City/State/Zip
Other phone # (if applicable)
Information About Your Boxer
Name of Dog
Spayed/Neutered
Yes
No
Age
Purebred?
Yes
No
Sex
Male
Female
Housebroken?
Yes
No
Partly
Mostly, but has occasional accidents
Veterinary Care Status
Rabies?
Yes
No
Date of Last Heartworm Test
Distemper?
Yes
No
On Heartworm Preventative?
Yes
No
Bordetella
Yes
No
Name of Veterinary Clinic
Where Did You Obtain This Dog?
Name of Breeder
Name of Humane Society
Obtained via Other Means
Have you contacted them to return the dog?
How long have you had the dog?
Is the dog good with kids?
Is the dog good with cats?
Other Information
Why are you surrendering the dog?
Any medical problems?
Any behavioral problems?
If you need to surrender the dog by a particular date, please provide the date.
Has this dog ever bitten anyone or another dog?
If yes, please explain the circumstances.
Has this dog ever nipped anyone or another dog?
If yes, please explain the circumstances.
Has this dog ever snapped at anyone or another dog?
If yes, please explain the circumstances.
Anything else we should know about the dog?
Please attach a photo.
Photo #1
Photo #2 (if applicable)
Recaptcha
*
