FHRNE Intake Form
Sending person's name
First Name
Last Name
Sending person's Email
example@example.com
Sending Rescue Name
Sending Rescue Email
example@example.com
Name of person who will put dog on transport
First Name
Last Name
Email address for person who will put dog on transport
example@example.com
Phone Number for person who will put dog on transport
-
Area Code
Phone Number
Which transport stop is preferred
Date
-
Month
-
Day
Year
Date
Dog’s Name (litters require just one intake form with all names listed. Please send separate emails with each additional puppy's name in the header and photos of that pup along with a one line description of pup's personality, eg dominant, submissive, high energy, low energy, shy, anxious, etc)
*
1. 2. 3. 4. 5. 6. 7. 8. 9.
Dog photo front face
Dog photo side face
Dog photo full body (all dogs full body)
Photo of parent (if available)
Breed
Gender
Color
Age
Weight
Spayed or neutered before rescue?
Spay/neuter date
-
Month
-
Day
Year
Date
Microchip Number (if applicable)
Vaccine Type
Rabies
Distemper combo(s)
Bordatella
Rabies Vaccine Date
Distemper Vaccine Date
Distemper Vaccine Date
Distemper Vaccine Date
Bortadella Vaccine Date
Foster Contact Name
Foster Email
example@example.com
Foster Phone
Best way to contact
email
phone
Best time to call
morning
afternoon
evening
Are you fostering this dog? If you are not the foster for this dog, please include the actual foster's name even if you don't wish that person to be the contact person.
Foster/Sub Foster
Foster home environment
(quiet household, busy household, rural, urban)
Reason for Rescue
stray, owner surrender & why, shelter
How long has dog been in foster care?
Were there any transitional issues? If so, please describe even if those issues are better now.
How long did the dog take to transition?
Is dog suitable for city/apartment?
Yes
No
Living inside or outside (Note:dogs should have some experience living inside prior to transport):
inside or outside
Energy level
low,med, high
How much exercise would dog need?
2-3 short walks per day
Long walks daily
lots of active play in an enclosed area
How is the dog currently exercised?
Favorite Activities/Likes & Dislikes/Fears:
Is dog OK if left alone for several hours (separation anxiety, destructive)?:
Socialized with people
yes/no/men, women, children:
History with children (include children's ages)
Any sign of prey drive?
Issues with other Dogs
fearful, food aggression, alpha dog, resource guarding
Type of play with other dogs
gentle
intermediate
rough
Cat Tested
Yes
No
If yes, please describe experience with cats in detail.
Crate Training
House Training
Obedience Training
Leash walking
pulls? Walks nicely?
Behavioral/Training Issues
mouthy, jumpy, shy, barking, chewing, nervous
Ideal Adoptive Home/Situation
Health or Medical Issues
i.e. old fractures, skin problems, eye infections, bad teeth, food allergies, deafness, blindness
General comments about this dog or about individuals in this litter:
Enter the message as it's shown
*
Submit
Should be Empty: