Intake Request Form - Almost There Rescue

Name*

First Last

Number*

Email*

Preferred method of contact*

Email
Text
Phone Call

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Intake type*

Found/stray
Owner surrender
Rescue transfer

Where did you find the dog(s)?*

When did you find the dog(s)?*

Where did you first get the dog(s) from?*

Name of organization*

Where did your organization first get the dog(s) from?*

When did you first get the dog(s)?*

Reason for surrendering*

Would you like to be considered for Mutternity Leave?***

No
Yes

**Learn more about Mutternity Leave

Tell us what animals you'd like us to take*

Pregnant mom
Mom actively nursing
Puppies only

Which of the following has mama displayed*

Which of the following have one or all of the puppies displayed*

Please describe the medical status of the puppy(s) to the best of your ability. (When did the symptoms you selected start? What else have you noticed?)*

Please describe the medical status of mama dog to the best of your ability. (When did the symptoms you selected start? What else have you noticed?)*

Do you have information on the father of the puppies?*

Yes
No

Do you have information on the mother and/or father of the puppies?*

Mother
Father
Both mother and father
No. I don’t know the mother or father

Mama dog's name (if known)*

Mama dog's estimated weight*

Mama dog's breed(s)*

Mama dog's estimated age (Please write her birthday if you know it)*

Which vaccines has mama dog had?**

DHPP
Bordetella
Rabies
All of the above
None of the above (mama has NOT been vaccinated)

*If you cannot remember, your vet should be able to tell you.

Please write the date she last received her DHPP vaccine.*

Please write the date she last received her Bordetella vaccine.*

Please write the date she last received her Rabies vaccine.*

Father dog's estimated weight*

Father dog's breed(s)*

Puppies only:*

Orphan puppies 4-16 weeks old
Bottle babies under 4 weeks old

WE UNDERSTAND THE URGENCY AND WILL RESPOND ASAP!

Number of puppies*

Age of puppies*

Please choose days, weeks, or months*

Puppies date of birth (if known)*

Puppies: Breed(s)*

Mama dog: Please describe her background to the best of your ability. (ie stray, limited socialization, owner surrender due to x).*

Father dog: Please describe his background to the best of your ability. (ie stray, limited socialization, owner surrender due to x).*

Mama dog: Please describe her behavior and temperament to the best of your ability.*

Mama dog: Does mama let people handle her pups? How does she act when her pups are being held?*

Father dog: Please describe his behavior and temperament to the best of your ability.*

Mama dog: Please describe her behavior toward: Other Dogs*

Mama dog: Please describe her behavior toward: other dogs PRIOR to having puppies.*

Mama dog: Please describe her behavior toward: Strangers (people she doesn't know)*

Mama dog: Please describe her behavior toward: Children*

Mama dog: Please describe her behavior toward: Cats*

Father dog: Please describe his behavior toward: Other Dogs*

Father dog: Please describe his behavior toward: Strangers (people he doesn't know)*

Father dog: Please describe his behavior toward: Children*

Father dog: Please describe his behavior toward: Cats*

Mama dog: To your knowledge, has she ever bitten or snapped at a person? If so, please describe the incident(s) in detail.*

Father dog: To your knowledge, has he ever bitten or snapped at a person? If so, please describe the incident(s) in detail.*

If you have further information about adult dogs or the puppies that may be helpful to us, please include it here.*

Photos

Drop files here or

Max. file size: 300 MB.

At least one photo must be added to complete your intake request. Thank you!

Vet Records

Drop files here or

Max. file size: 300 MB.

Please add any vet records or relevant documents on the dog(s) here. Thank you!