Canine Angels Service Teams

13475 N. Applegate Rd.
Grants Pass, OR. 97527
888 K9 ANGLSĀ  orĀ 541 846-6400
www.Canine-Angels.org email: info@Canine-Angels.org

Donated Dog Inquiry Form

DONOR INFORMATION

Name:

Address 1:
Address 2:
City:
State:
Zip:

Phone:
E-Mail:
How did you find Canine Angels?

PUPPY / DOG INFORMATION
Breed:
Age:
Name:
Has dog been spayed or neutered? Yes No
Is dog current on all vaccinations (Rabies, Bordetella, DHLPPC)? Yes No
Is dog heartworm negative and on heartworm preventative? Yes No
Does dog have CEE/CERF showing no eye diseases? Yes No
Does dog have x-rays showing OFA good/excellent? Yes No
Has dog had any health problems or genetic conditions, or is there a family history of either? Yes No
Does dog have any allergies or is there a family history of allergies? Yes No
Has dog been exposed to any contagious diseases such as Parvo, Giardia, Papilloma (dog warts), or Kennel Cough? Yes No
Can you provide Canine Angels with pedigree information for your dog? Yes No
Does the dog have AKC paperwork? Yes No
Does your dog go out into public with you (ex. pet stores, feed stores, parks, pet-friendly stores and places)? Yes No
Has the dog been socialized with children, other dogs and cats? Yes No
If so, what was the dog's reaction?
Is there anything else about the dog you would like us to know?