Dog History Form - Ottawa Humane Society

Owner Information

You need to surrender your pet to the OHS because: *

Moving and unable to bring pet (please provide moving date below)
Cost of having a pet
Pet is injured/ill (please provide more information below)
Pet is aggressive
Behaviour issue
Too many animals
Not enough time
Pet is house soiling
Other (please provide more information below)
Prefer not to say

Are you surrendering your pet for end of life care (humane euthanasia)? *

Yes
No

Please share your moving date. *

Please share details of your pet's injury or illness. *

Please share the reason you are considering surrendering your pet to the OHS. *

Your Name *

First Last

Email *

Phone Number *

Address *

City *

Province *

Postal Code *

Information About Your Pet

Name *

Age *

Gender *

How many puppies are in the litter? *

Breed *

Do you know of any past or current medical conditions? If yes, what are they? *

Is your pet currently on medication? If yes, please specify. *

Is your pet currently on a special diet? If yes, please specify. *

What is the name of your pet's veterinarian?

Your Pet's History

How long have you owned your pet? (Number of years, months, etc.) *

How did you acquire your pet? *

Ottawa Humane Society
Found them outside
Pet Store
Friend or relative
Online
Placement Group
An animal shelter that wasn't the Ottawa Humane Society
Breeder

Please share the name of the animal shelter, placement group or breeder. *

You live in the: *

City (urban area)
Suburbs
Country

What is your home environment like (number of people, quiet, active, etc.)? *

Is there anything else we should know about your home environment?

How is your dog around children? *

Are children regularly in your house with your dog? *

Yes
No

What are the ages of children who are regularly in the house with your dog? *

What animals has your dog lived with? *

No other animals
Dogs (Male)
Dogs (Female)
Dogs (Male and Female)
Cats (Male)
Cats (Female)
Cats (Male and Female)
Other

Please share other species of animals your dog has lived with. *

Your Pet's Behaviour

How does your dog react to familiar people? *

How does your dog react to familiar men? *

How does your dog react to familiar women? *

How does your dog react to familiar children? *

How does your dog react to new people? *

How does your dog react to new men? *

How does your dog react to new women? *

How does your dog react to new children? *

How does your dog react to familiar dogs? *

How does your dog react to familiar cats? *

How does your dog react to familiar small domestic animals? *

How does your dog react to new dogs? *

How does your dog react to new cats? *

How does your dog react to new small domestic animals? *

Does your dog try to chase any of the following? *

What does your dog try to chase? *

How does your dog play? *

Gentle
Somewhat rough
Very rough
Doesn't play

When playing, does your dog: *

Jump
Growl
Bark
Grab clothing
Bite lightly
Bite hard
None of the above

Is there anything your dog is afraid of? *

How does your dog usually react to being hugged? *

How does your dog usually react to being bathed? *

How does your dog usually react to being brushed? *

How does your dog usually react to having their paws wiped? *

How does your dog usually react to having their nails trimmed? *

How does your dog usually react to visiting the veterinarian? *

How does your dog usually react to visiting the groomer? *

Does your dog urinate and defecate outside? *

Yes
No, they are paper trained
No

Does your dog urinate or defecate in the house? *

Yes
No

How often? *

Daily
Once or twice a week
Once or twice a month

Is it only urination or defecation? *

Urination only
Defecation only
Both

How long is your dog left alone each day? *

Never
One (1) to three (3) hours
Four (4) to eight (8) hours
Nine (9) to twelve (12) hours
More than twelve (12) hours

Where is your dog when they are left alone? *

Outdoors
Free in the house
Confined to a room
In a crate
My dog is never alone

When alone, does your dog show any of these behaviours? *

How long has your dog been showing the behaviour? *

Did any changes happen around the time the behaviour started? *

What change happened when the behaviour started? *

Have you tried to crate train your dog? *

Yes, successfully
Yes, unsuccessfully
No

Have you taken any steps to change your dog's behaviour? *

What steps have you taken to change your dog's behaviour? *

Which method helped your dog the most and which method helped the least?

Can your dog stay outside in your yard without anxiety? *

Yes
No
I don't know

Has your dog bitten a person? *

Yes
Yes, and the bite broke the skin
Yes, and the person needed stitches
No

Please explain what caused your dog to bite (handling, fear, etc.) and when the bite happened. *

Has your dog bitten another dog? *

Yes
Yes, and the other dog needed veterinary care
No

Please explain what caused your dog to bite and when the bite happened. *

Has your dog ever been aggressive towards a family member in the house petting them or touching their food bowl while eating? *

Has your dog ever been aggressive towards a family member in the house petting them or touching their bone, rawhide, pig's ear or other treat? *

Has your dog ever been aggressive towards a family member in the house petting or touching them while your dog has a stolen food item? *

Has your dog ever been aggressive towards a family member in the house petting or touching them while your dog has a stolen object? *

Has your dog ever been aggressive towards a family member in the house petting or touching them while your dog has a toy? *

Has your dog ever been aggressive towards a family member in the house petting or touching them while your dog is sleeping? *

Has your dog ever been aggressive towards a family member in the house pushing or pulling your dog off of furniture? *

Has your dog ever been aggressive towards a family member in the house approaching your dog while they are next to another family member? *

Has your dog ever been aggressive towards a stranger approaching a family member? *

Has your dog ever been aggressive towards a stranger approaching the yard or house? *

Has your dog ever been aggressive towards a stranger entering the house? *

Has your dog ever been aggressive towards a stranger approaching a vehicle your dog is in? *

Has your dog ever been aggressive towards a dog or cat approaching any resource (food, bone, bed, etc.)? *

Has your dog ever been aggressive towards a dog or cat approaching a family member? *

Has your dog ever been aggressive towards a dog or cat approaching the yard or house? *

I understand that some animals have medical or behaviour issues that make them difficult or impossible to rehome, and the OHS will not adopt out any animal believed to be a public safety risk. Additionally, some animals become highly stressed in a shelter environment, which makes them more susceptible to illness and, despite aggressive veterinary treatment, unlikely to recover from such illness. The OHS will not keep an animal in a state of suffering when their prognosis is poor or when the OHS lacks the resources to restore the animal’s health. I understand that these animals will be humanely euthanized by caring, professional staff. The OHS does not humanely euthanize healthy, adoptable animals regardless of length of stay or lack of space. *

I agree

I understand that I will need to provide proof of ownership for the animal being surrendered, such as City of Ottawa registration, a bill of sale, a receipt from my veterinary clinic, or photos. *

I agree

I understand that I will need to provide a piece of photo identification for myself at the surrender appointment. *

I agree

Is there any additional information you would like to share about your pet?

If possible, please provide your pet's veterinary records.

Accepted file types: pdf, Max. file size: 8 MB.

If possible, please provide a photo of your pet. (JPEG format)

Accepted file types: jpg, Max. file size: 8 MB.