Dog Intake Form - Pet Haven of Minnesota

Intake Coordinator Information

Intake Coordinator Name(Required)

Intake Coordinator Email(Required)

Email of person submitting this form

If you are submitting the intake form but you are not the intake coordinator, please enter your email here so that you get a copy of the submission via email to add to Sparkie.

Foster Information

Is this dog an owner surrendered foster?

Are they being fostered by their owner?

Foster Name(Required)

Foster Email(Required)

Foster Mentor(Required)

Dog Information

Dog Name(Required)

Sparkie ID(Required)

Date of intake or transfer(Required)

Adoption Fee(Required)

Based on the age we know for the dog, please select the appropriate adoption fee. If unknown or a complex situation, you may select unknown.

Where did this dog come from?(Required)

Reason for return?

Reason for transfer(Required)

"Other" transfer source - please explain(Required)

You selected "other" for where this dog came from. Please describe the dog's situation here.

Does our puppy care coordinator need to be notified?(Required)

Please choose yes if the dog is 12 weeks old or younger, a pregnant/nursing mom, or is a situation that our puppy manager has already been involved in.

Yes

The following were dispensed to the foster at intake:(Required)

Heartgard (heartworm preventative)

Nexgard (flea/tick preventative)

Frontline (flea/tick preventative)

Pyrantel dewormer (three doses to be given two weeks apart)

Panacur dewormer (seven doses to be given once a day for seven consecutive days)

None

Urgent Vetting/Behavioral Support Needed(Required)

If we think that the dog or foster may need vetting or behavioral support immediately after intake, please indicate that here.

No, not needed

Yes, urgent vetting or behavior support may be needed

Please describe what we know about the urgent support that may be needed.(Required)

Additional Notes

Original Fosters Needed Facebook Post

If applicable, please paste the original post from the Fosters Needed Facebook page here. If you do not have it and the dog was posted on Facebook, please ask the original poster for the initial information and include it in a Sparkie comment on the dog's profile.