Your Name (required)
Your Email (required)
Your Phone # (required)
Address (required)
Dog's Name (required)
Dog's Age (required)
Dog's Weight (required)
Pet Gender? MaleFemale
Is the dog spayed/neutered? YesNo
Is he/she up to date on vaccines? YesNo
On heartworm preventative? (required) YesNo
Is the dog good with other dogs? (required) YesNo
Is the dog good with other cats? (required) YesNo
Is the dog good with kids? (required) YesNo
Does the dog have a microchip? (required) YesNo
Is your dog kept indoors or outdoors? (required) InsideOutside
Dog Breed (required)
Where did you get this dog? (required) BreederShelterRescueOther
If you selected "Other", please describe how you acquired the dog?
Are there any known behavorial problems or heath problems? (required)
Is the dog crate trained? YesNo
Does the dog have separation anxiety? YesNo
If yes, please explain:
Has the dog ever bitten anyone or another dog/animal? YesNo
Why are you rehoming your dog? (required)
How long can you keep the dog while we try to find a home for him/her? (required)
Please provide us with current or previous vets name, address, and phone number: (required)
Note: Please send photos of your pet to info@aplmercer.com.