Intake Request - Louisiana Dog Rescue

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Louisiana Dog Rescue

Surrender A Dog

PLEASE READ: Louisiana Dog Rescue is not an open intake rescue. We are only able to intake the dogs we have room for. When you submit this form, we will contact you if we are able to intake your dog. By submitting this form, you agree we are allowed to forward any information to other rescues that we think may be able to help.

Intake Request Form

* Indicates required field

Name *

First

Last

Dog’s name *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Location of the dog (City, State) *

Gender *

Male Female

Age *

Breed *

Weight *

How long have you owned this dog? *

Where did the dog originally come from? *

Is the dog spayed or neutered? *

Yes No Too Young (under 6 months)

Is the dog UTD on yearly vaccinations? *

Yes No

Has the dog been tested for heartworms? *

Yes No

Date of heartworm test *

If yes, what were the results? *

Positive Negative Not Tested

Has the dog been on heartworm prevention? *

Yes No

Is the dog microchipped? *

Yes No

Date of the dog's last vet visit: *

Does the dog have any known medical problems? *

Is your dog good with kids? *

Yes No Hasn't been around kids

Is your dog potty trained? *

Yes No

Please check all that apply: *

Friendly Friendly with Strangers Leary of Strangers Active Lazy Aggressive Playful Good with Other Dogs Good with Cats

Why are you rehoming this dog? *

Would you be sending a donation if we are able to intake your dog? *

Yes No

Donation Amount *

Please upload a picture of the dog (Pictures are strongly encouraged) *

Max file size: 20MB

Submit

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