New Hope Vizsla Rescue

NEW HOPE VIZSLA RESCUE Date: ______INTAKE FORM PREPARED BY:______

Owner Information Name Address Citv/State/Zip Phone numbers)

Dog Information Dog's Name Date obtained Age obtained and age now.

Where obtained? Name Describe process in finding this breeder. From whom?

Sex Male Neutered or spayed? When? Female

Does the dog live? Indoors Crate trained Outdoors Travels well in cars Used to kennel Housebroken Is the dog? Shy Quiet Has this dog ever bitten anyone. Please describe. Friendly Obedient Playful Nervous Active Outgoing Protective

Is the dog good with? Men Describe. Women Children - - under 5 - -(5-12) - - teenagers Other dogs Cats Other small animals Is the dog afraid of? Strangers Discuss fears Storms Guns Vacuums Other Frequent behaviors? Chewing Describe behaviors. Digging Barking/howling Chasing cars/bikes Jumping on people Escaping Other

Obedience training? Yes - at what age\ Where was training taken?

This may be formal or No Commands known training that owner provided Does the dog have Yes Describe favorite toys or games? No

What is the normal Daily walk Other. Very important, please describe. exercise pattern for this Free run in fenced dog yard Free run - open land Hours per day in crate Does the dog have natural Yes Describe behaviors. hunting ability, or do you hunt with the dog? No

What kind of food docs Dry Describe. What brands of food eaten the dog eat? Canned Table food Other Supplements given Is the dog on medication? Heartworm preventive Please describe. Thyroid Antibiotics Cortisone Please provide Veterinarian name and contact information: Flea/tick treatments Seizure meds Other How would you describe the general temperament of your dog?

What kind of family do you think would best fit your dog's needs?

Why are you placing your dog in rescue?