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Dog Surrender Questionnaire

SafeHaven Humane Society receives more requests than we have space to accommodate. Submitting this form does not mean we have agreed to accept your dog or cat. We will contact you to schedule an assessment appointment for an evaluation, which includes a brief behavior and health assessment. If an assessment appointment is offered bring the animal’s medical records or email them prior to the appointment.

Important:

Only one animal per form. If you have multiple animals that you wish to surrender they will each need a form submitted. Puppies under 3 months may be on the same form, but make sure to indicate how many there are.

Dog's Sex*
Is your dog spayed/neutered?*
Does your dog have a microchip?*
Where did you acquire this dog?*
If your dog is from another rescue or shelter have you tried returning your dog to them?
Has your dog ever bitten a person?*
Has your dog ever bitten a person in the last 10 days?*
Has your dog ever bitten another animal?*
Has your dog bitten another animal in the last 10 days?*
Has your dog ever killed another animal?*
Has your dog ever been seen by a veterinarian?*
How does your dog do at the veterinarian?
How would you describe your dog most of the time? (check all that apply)*
What words does your dog understand? (check all that apply)*
Can this dog be left home alone for 8 hours a day without issues?*
Where is this dog when no one is home?*
How is your dog confined when outdoors?*
Has your dog ever escaped the yard?*
Housetraining*
Is your dog possessive or protective?*
Would you recommend placing this dog in a home with other dogs?*
Does your dog currently live with any of the following? (check all that apply)*
Describe your dog's play style with other dogs. (check all that apply)*
Please check everything that would frighten this dog*
Would you recommend placing this dog in a home with cats?*
Would you recommend placing this dog in a home with kids?*
Has this dog done any of the following when interacting with adults in the home?*
Has this dog done any of the following when interacting with children in the home?*
Has this dog done any of the following with pedestrians?*
Has this dog done any of the following with cars, bikes, or skateboards?*
Has this dog done any of the following with resident dogs?*
Has this dog done any of the following with resident cats?*
Has this dog done any of the following with dogs outside of the home?*
Has this dog done any of the following with wildlife and/or livestock?*
How does your dog do on car rides?*
This field is for validation purposes and should be left unchanged.

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SafeHaven Humane Society is a 501(c)3 organization.

Our tax-ID number is 93-0676661 and donations are tax-deductible to the extent allowed by law.

Hours
We are currently open 7 days a week:
12:00pm – 5:00pm
Address
32220 Old Hwy 34, Tangent, OR 97389
Contact
info@safehavenhumane.com
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