Portland – Dog IntakePortland Campus Intake - Dog Personality General InformationDog's name*Dog’s age or approximate age*Dog's breedDog's sex* Male Female UnsureIs your dog spayed/neutered? Yes No UnsureDoes your dog have a microchip? Yes No UnsureHow long have you owned this dog?Where did you acquire this dog?* Oregon Humane Society – Portland Campus Oregon Humane Society – Salem Campus Other Shelter/ Rescue Organization: Found as Stray Breeder/ Pet Store Private Party/ Courtesy Posting Family/ RelativeName of Other Shelter/Rescue Organization*Has your dog ever bitten anyone or any animal?* Yes NoDid this incident break skin? Yes NoHas your dog bitten anyone or any animal in the last 10 days?* Yes NoDid this incident break skin? Yes NoHistoryWhy are you rehoming your dog?If we could help you resolve this issue would you be interested in keeping this dog?What would you like new owners to know about this dog?Has your dog ever been seen by a veterinarian? Yes NoWhen was the last time your dog went to the vet?What is the name of the clinic?How did the dog react to going to vet?Are there places on the dog's body he/she does not like being touched, brushed or petted? Yes NoWhere and what does the dog do?Home Life, Training & MannersHow would you describe your dog most of the time? (check all that apply) Affectionate Playful Lap dog Friendly with visitors Shy with family Shy with visitors Independent Very active Not very active Talkative Uses mouth/jumps up in playWhat words does your dog understand (check all that apply)? Sit Stay Down Come Leave it Drop Wait Heel Off OtherWhat other words does the dog understand?What are your dog’s favorite things to do? i.e. favorite toys, treats and/or activities.How does your dog do on leashed walks?Can this dog be left alone in the house for 8 hours a day without issues? Yes NoIf not, please explain what the animal does:Where was the dog when no human members of your family were at home? Free roam of the house Confined particular room In garage or basement Crated OutsideDid your dog ever escape the yard? Yes NoIf yes, how?Housetraining: No accidents Urinates inside home Defecates inside homeHow often does the dog urinate inside the home?How often does the dog defecate inside the home?Is this dog possessive or protective? Yes NoIf yes, when is your dog possessive or protective? Of food (towards people) Of toys (towards people) Of bedding (towards people) Of food (towards other animals) Of toys (towards other animals) Of bedding (towards other animals) Of property Of owner/family OtherIf you chose other, please explain:Does your dog live with any of the following (check all that apply): Large dogs Small dogs Cats Small animals Livestock ChildrenWhat ages are the children?Would you recommend placing this dog in a home with other dogs?* Yes NoWhat reason(s) would you recommend placing this dog in a home with other dogs?What reason(s) would you not recommend placing this dog in a home with other dogs?*Describe your dog’s play style with other dogs (check all that apply): Will play with all dogs Does not enjoy playing with other dogs at all Picky about the dogs they like Hangs out with other dogs rather than plays Plays rough with other dogs Chases or herds other dogs Barks constantly Prefers dogs that are gentle or indifferentWould you recommend placing this dog in a home with cats?* Yes NoWhat reason(s) would you recommend placing this dog in a home with cats?What reason(s) would you not recommend placing this dog in a home with cats?Would you recommend this dog be around children regularly? Yes NoWhat reason(s) would you recommend placing this dog in a home with children?What reason(s) would you not recommend placing this dog in a home with children?Please check all that frighten this dog: Babies or toddlers School-age children Teenagers Men Women Strangers/visitors People in uniform Veterinarian/groomer Loud voices/yelling Fireworks/loud noises Erratic or sudden movement Water Unpredictable children Broom/vacuum Riding in car Loud vehiclesHas this dog done any of the following when interacting with adults in the home? Barked at Growled Snapped Bitten None of the aboveHas this dog done any of the following when interacting with the children in the home? Barked at Growled Snapped Bitten None of the aboveHas this dog done any of the following when interacting with visiting adults? Barked at Growled Snapped Bitten None of the aboveHas this dog done any of the following when interacting with visiting children? Barked at Growled Snapped Bitten None of the aboveHas the dog done any of the following with a vet or groomer? Barked at Growled Snapped Bitten None of the aboveHas the dog done any of the following with pedestrians? Barked at Growled Snapped Bitten None of the aboveHas this dog done any of the following with cars, bikes or skateboards? Barked at Growled Snapped Bitten None of the aboveHas this dog done any of the following with resident dogs? Barked at Growled Snapped Bitten None of the aboveHas this dog done any of the following with dogs outside of the home? Barked at Growled Snapped Bitten None of the aboveHas this dog done any of the following with resident cats? Barked at Growled Snapped Bitten None of the aboveHas this dog done any of the following with cats outside of the home? Barked at Growled Snapped Bitten None of the aboveHas this dog done any of the following with wildlife and/or livestock? Barked at Growled Snapped Bitten None of the aboveYour InformationYour name* First Last Please enter your address below* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your phone number*HiddenEmailEmail* Please only include one (1) email address. If you do not have an email address, please put "[email protected]". ex: [email protected]The average daily cost for caring for each animal we receive is $150. We ask for a donation from each family using our services to help us in caring for your pet. Please indicate the amount you can comfortably afford to donate. Every dollar helps!*If you require language interpretation services, please select your preferred language below. Arabic Cantonese French German Italian Japanese Korean Mandarin Persian Portuguese Russian Spanish Vietnamese CommentsThis field is for validation purposes and should be left unchanged.
