Name
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First Name
Last Name
Email Address
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
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(###)
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Adopted Pet's Current Name
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Adopted Pet's Nickname
I verify that this pet was adopted from Wright-Way Rescue.
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This form is only applicable to Wright-Way Rescue adopters.
Please tell us why you are giving up this pet. Please be honest as this will help us understand why this pet is not working out in it's current home and how we can re-home the pet in a more appropriate home.
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If you are giving up your pet due to behavioral issues, would you consider keeping your pet if these issues were resolved?
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Yes
No
Age of Pet
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How old was this dog when you acquired him/her?
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How long ago did you adopt your pet?
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Including your home, how many homes has this dog had?
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Sex
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Male
Female
Unsure
Breed
Pet's Color
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Did this pet receive annual exams by a veterinarian?
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Yes
No
Unsure
Please provide the name of your pet's veterinarian.
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Please provide the phone number of your pet's veterinarian
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Is your pet up to date on monthly heartworm prevention?
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Yes
No
When did your dog receive his/her last dose of heart worm preventive medication?
Does this animal have any medical problems or previous injuries that require special attention or a special diet?
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Please explain.
Please check all conditions that your dog has been diagnosed with or has been treated for:
If you answered other, please explain.
How does this dog behave at the vet’s office?
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Calm
Anxious, but calms down
Anxious, nips and growls
Very stressed, must be muzzled to avoid biting
Check all traits that best describe your canine friend’s personality:
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If you answered other, what other words would you describe your dog?
What’s your dog’s favorite style of play?
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Check all that apply.
If you answered other, what other words would you describe your dog's play style.
Was this dog:
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Check all that apply
This dog sleeps:
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Check all that apply
Is this dog housebroken?
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Yes, completely
No, has frequent accidents
Mostly, has occasional accidents
Only has accidents while left alone for long periods
While outside, my dog was:
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Check all that apply
Have you had any problems keeping this dog confined?
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Check all that apply
Is this dog ever crated?
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Check all that apply
If crated, this dog was:
Check all that apply
What kind of exercise did this dog receive?
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Check all that apply
Has this dog regularly been around children?
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Yes
No
Unsure
If yes, please indicate the age range of children:
Check all that apply
How does this dog behave around children?
Check all that apply
If you answered other, please explain.
How does this dog behave around adults?
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Check all that apply
If you answered other, please explain.
Describe how this dog behaves when people come to visit
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Check all that apply
If you answered other, please explain.
How does this dog behave around other dogs?
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Check all that apply
How does this dog behave around cats?
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Check all that apply
My dog knows:
Check all that apply
If you answered other, please explain.
How does this dog behave on a leash?
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Check all that apply
Does this dog have any of the following behaviors you consider a problem?
Check all that apply
How is this dog disciplined?
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Check all that apply
What would you describe to be the “perfect” home for your dog?
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Tell us your favorite characteristic about your dog
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Does your dog have an behaviors, quirks or habits that you are not fond of?
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Please feel free to add additional comments that you think would be helpful to rescue staff or potential adopters.
Has this dog ever been aggressive towards people or animals? If yes, please answer and continue to the next section. If no, please continue to the training section.
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Focus Of Aggression:
Date of Aggressive Incident(s):
Was there a witness to your dog's aggressive behavior?
If you answered yes, who was the witness?
Type of Behavior:
Please select all that apply.
Has your dog bitten?
If you answer, yes, please continue to the questions below.
Type of Bite:
Date of Bite
MM
DD
YYYY
Part Of Body Bitten:
Was there a witness to your dog's biting?
If you answered yes, who was the witness?
Did the bite break the skin?
Did the person go to the hospital?
Did the bite wound require stitches?
Is there any pending or potential litigation regarding the bite?
HAVE YOU OR A DOCTOR REPORTED THE SITE TO THE BOARD OF HEALTH?
Who reported?
CASE #
Was a warning given by the dog?
If yes, what type of warning?
Did the animal continue to bite after the first bite:
If yes, explain in full detail:
Please select the bite that most closely describes this incident. Please answer honestly and to the best of your ability.
How did you stop the animal from biting?
Why do you feel the animal bit?
What was the animal doing prior to the incident?
Where did the incident occur (exact address and county)?
Explain in full detail any other details about the incident that occurred:
Did the incident involve another animal?
If yes, describe age/type of animal:
What is the animal’s relationship to the animal involved (lives with, stranger, visitor, etc):
Did the incident involve a person?
If yes, age of person(s) involved:
What is the animal’s relationship to the people involved (lives with, stranger, visitor, etc):
What action was taken by the adopter during the incident:
Was this the first time the animal exhibited this behavior?
If NO, when did the animal first begin to exhibit this behavior?
Did the animal look sorry afterwards?
Has the animal been allowed on the furniture?
Does the animal sleep in bed with a person?
If you have provided professional training for this pet, please provide name and number of the trainer.
When/Frequency of training sessions:
If you have had professional training for this dog, please immediately call the trainer and release all records to Wright-Way Rescue.
Have you worked with a professional trainer in regard to the behaviors you are returning this pet for?
Yes
No
Equipment I use with my dog (check all that apply):
The dog has (check all that apply):
My dog is generally:
If your dog receives leash corrections please describe their response to such:
What commands do you feel your pet follows consistently?
How soon do you need to give up this pet?
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If you schedule the return of an adopted pet and do not show up for your appointment, your pet will still be accepted back; however, they will be added to the end of our wait list if one exists at the time. Wright-Way Rescue schedules the return of pets adopted 8 days or more ago to ensure that we can properly house and care for the animals in our care. We are a no-kill shelter and operate at full capacity. Do you understand Wright-Way Rescue's policies and procedures on returning a pet adopted 8 days or more ago?
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I certify that the information above is true and accurate and that I am the legal and sole owner of the pet above.
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Because our resources to do this are already extremely limited we regret that we will be unable to give updates on any pet returned.
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