Intake

Pre-intake Questionnaire

Please fill out the following information with complete honesty as it will allow us to take the best path forward for your animal. This form helps us learn about you and your pet. It is the first step in the conversation — not a formal commitment from either side.

Owner Information

Full Name *

Email Address *

Phone Number *

Preferred Contact Method *

Address *

About Your Animal

Animal's Name *

Breed *

Age *

Color *

Sex *

Spayed / Neutered? *

Microchipped? *

Current on Vaccines? *

Is your animal housebroken? *

Where does your animal live most of the time? *

Veterinarian Name / Clinic *

Reason for Surrender *

Describe your animal's personality *

Does your animal have any medical issues? *

With whom did your animal live? (select all that apply) *

AdultsChildrenCatsDogs

Please describe your animal's interactions with other dogs, cats, and/or children in as much detail as possible *

Has your animal ever shown signs of aggression towards humans? *

Has your animal ever shown signs of aggression towards other dogs? *

Has your animal ever bitten anyone? *

Acknowledgment & Signature

By typing my name below as an electronic signature, I attest that all information provided in this questionnaire is true, accurate, and complete to the best of my knowledge. I further acknowledge that submission of this questionnaire does not constitute an acceptance of intake by Vermont Pet Guardians. Completion of this form is for informational purposes only. Vermont Pet Guardians reserves the right to decline any intake request.

Electronic Signature (type your full name) *

Fields marked with * are required.