Atlanta Lab Rescue

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Owner Information

Name *
Phone *
Email Address *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

General Information About Your Dog

Name of Lab? *
Age *
Weight *
Sex *
MaleFemale
Microchipped? *
YesNoDon't know
Please provide the number.
Housetrained? *
YesNo
Crate Trained? *
YesNo
How long have you owned your lab? (years/months) *
Where did you acquire your lab? *Rescue group? Shelter? Breeder? Stray? (Please provide name of group/shelter/breeder.)
Where does your dog stay during the day and at night? How many hours is he/she left alone? *
Reason for giving up your lab? *

Medical Information

Spayed or Neutered? *
YesNo
Up-to-Date on Vaccines? *
YesNo
Date of Last Annual Check-Up?

Heartworm/Flea Prevention

On Monthly Heartworm Prevention? *
YesNo
Date of Last Heartworm Preventative dose?
Date of Last Heartworm Test?
Positive or Negative for Heartworms? *
PositiveNegativeBeen over a year since last heartworm test.Have not had a heartworm test.
Is your dog currently being treated for Heartworms?
Please describe the treatment, the prognosis and where your dog is being treated.

Allergies/Skin Condition

Does your dog have Allergies or Skin Conditions? *
YesNo
If Yes, Please Describe:
Has your dog had any surgeries, other than spay/neuter? *
YesNo
If Yes, Please Describe:
Provide dates, vet name, results.
Has your dog had any litters? *
YesNoN/A, male dog
If yes, how many and when?
Please describe any other medical conditions: *

Vet Information

Vet Name?
Vet Phone?
Vet Address?
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Behavioral Information

Reaction to other dogs: *Calm? Submissive? Nervous? Aggressive?
Reaction to cats: *Good? Bad? Aggressive? Doesn't notice? Never been around a cat?
Reaction to strangers: *Friendly? Submissive? Shy? Fearful? Aggressive?
Reaction to children: *Please list number and ages of children dog has lived with previously.
Has your dog ever growled or bitten anyone? *
GrowledBittenNo
Is your dog possessive of food or toys? *
ToysFoodTreatsNo
Can you grab your dog's collar? Touch anywhere? *Can you physically handle your dog with ease?
Does your dog chew or destroy things (excluding dog toys/treats)? *
YesNo
Any behavioral issues? *
Aggression? Fears? Phobias?
Describe how you correct your dog for inappropriate behavior: *

Additional Information

Does your dog know basic commands? Please describe:
Does your dog walk with ease on a leash?
YesNo
Comfortable riding in a car?
YesNo
Likes to go running?
YesNo
Is your dog allowed on the furniture?
YesNo
Please provide any additional information that will help us with your dog:
Please upload a good picture of your dog:
Agreement By submitting the this form, you are agreeing that all of the information you have provided above is true and complete and submitted for consideration to surrender your dog.

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Atlanta GA 30325

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