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Shiba Inu Rescue
(S.O.S) Save Our Shibas
Rescue Dog
Information Sheet
1. Dog's Name:
_______________________________________________________
2. Age:
________________
3. Are you the dog's original owner?
_______________________________________
4. How long have you owned this dog?
_____________________________________
5. Where did you acquire this dog?
_________________________________________
6. Why are you bringing this dog to
Shiba Inu Rescue? Be specific.
___________________________________________________________________________________________________________________________________
7.
Is your dog housebroken? Yes ___ No ____
8. Does your dog occasionally "make
mistakes"? Yes____ No ____
9. Does your dog chew furniture or household
items? Yes ____ No ____
10. Does your dog dig holes? Yes ____ No ____
11.
Can your dog be left outside? Yes ____ No ____
12. Is the dog ever kept
outside? Yes ____ No ____
13. Does your dog ever go over or under the fence?
Yes ____ No ____
14. Does your dog get into the garbage? Yes ____ No
____
15. Does your dog chase cars or bicycles? Yes ____ No ____
16. Does
your dog ride well in a car? Yes ____ No ____
17. Does your dog walk on a
leash? Yes ____ No ____
18. Does your dog play games? Yes ____ No ____, if
yes what ________________________________________________________________
19.
Is your dog good with kids? Yes ____ No ____ Don't know ____
20. Is your dog
good with cats? Yes ____ No ____ Don't know ____
21. Is your dog good with
other dogs? Yes ____ No ____ Don't know ____
22. Has your dog ever bitten
anyone? Yes ____ No ____, If yes, please explain
_______________________________________________________________ Has your dog
ever nipped anyone? Yes ____ No ____, If yes, please explain
_________________________________________________________________
23. Does
your dog bark if someone comes to the door? Yes ____ No ____
24. Does your
dog bark or howl frequently? Yes ____ No ____
25. Has your dog had any
experience with obedience training? Yes ____ No ____, if yes, to what extent?
___________________________________________________
26. Is your dog crate
trained? Yes ____ No ____
27. Is your dog active or quiet in the house?
Active ____ Quiet ____
28. When was the last time your dog was at a vet?
_________________________, What was the reason?
______________________________________________________
29. Is your dog
current on vaccinations? Yes ____ No ____, If yes, do you have the certificates?
Yes ____ No ____
30. Has your dog been tested for heartworm? Yes ____ No
____, If yes, is the dog on a preventative? Yes ____ No ____ when given?
___________ OR did the dog test positive for heartworm? Yes ____ No ____
31.
What do you feed your dog? Name & type of food:
________________________________________________, How often?
__________________________________________
32. Had the dog been spayed or
neutered? Yes __ No ____, if yes, do you proof of surgery? Yes ____ No
____
33. Are AKC papers available for this dog? Yes ____ NO ____, Will they
be turned in with this dog? Yes ____ No ____
34. Additional comments:
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
