Home Rescue I Need to Surrender
I Need to Surrender

Do you have a Wheaten you are no longer able to care for?  If you do, please complete the Behavioral/Medical Summary below.  Someone from our Rescue Committee will contact you quickly.

If you are in an urgent situation, please contact:

Debie Scurr
Florida Rescue Co-coordinator
727-544-1294
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Melissa Nelson
Florida Rescue Co-coordinator
305-297-8956
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SCWTCGTB Behavioral & Medical Summary

 
Please complete the form below that will give us information about your dog.
 
 
 
 
 
 
 
 
Vaccination Record - please fill in with the last date each was given.
 
Rabies :: mm/dd/yyyy
 
DHHLP :: mm/dd/yyyy
 
Kennel Cough :: mm/dd/yyyy
 
 
Heartworm
 
Date Last tested? :: mm/dd/yyyy
 
 
Last Dose? :: mm/dd/yyyy
 
 
Last Dose? :: mm/dd/yyyy
 
 
If, yes, when? :: mm/dd/yyyy
 
 
 
Please indicate below if your dog is being or has been treated for problems with any of the areas listed.
 
 
 
 
 
 
 
 
Please fill in the information requested below regarding your dogs diet.
 
 
 
 
 
 
 
 
The following questions are regarding your dog's behaviors.
 






Has your dog ever exhibited agression towards any of the following? :: Check all that apply
 





If so, what type of aggression? :: Check all that apply
 
 
 
 
 











Does your dog know how to... :: Check all that apply
 
What word do you use for the following:
 
 
 
 
 
 
 
 
 
 
 
 
 
The following questions deal with how your dog behaves in the house.
 
 
 
 
 
 
 
 
 
The following questions deal with how your dog behaves outdoors.
 







Does your dog... :: Check all that apply
 
 
When we receive this form, one of our rescue coordinators will call you to talk about your dog. Please fill in the following information completely.
 
 
Your address :: Include address, city and state
 
Main Phone :: Include area code. Numbers only, no dashes, no spaces
 
Alternate Phone :: Include area code. Numbers only, no dashes, no spaces
 
 
If you have one, we would like a picture of your dog, please click here to upload it :: File types allowed: JPG, GIF, BMP, PNG
 
  
 
 
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