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Colorado Pug Rescue

Dog Evaluation form

Date*
MM slash DD slash YYYY
Dog's Name*
Dog's Age*
Dog's Gender*
- Male
- Female
Dog's Color*
- Fawn
- Black
- Brindle
Dog's Weight*
Evaluator's Name*
First Last
Evaluator's Phone Number*
Date First Contacted About Dog*
By Whom?*
Describe Rescue Situation*
Date Dog in custody*
MM slash DD slash YYYY
Signed Relinquishment Form?*
- Yes
- No
- Shelter Transfer Form
If from Shelter, Give Shelter Name
Is Dog Microchipped?*
- Yes
- No
Microchip Brand
Microchip Number
MEDICAL INFORMATION
Date of Medical Exam*
MM slash DD slash YYYY
Vet Clinic Used*
Dates of Vaccinations:
Rabies*
Distemper Combo*
Bordetella (if given)
Date of Heartworm Test*
Results*
- Positive
- Negative
Date Preventative Started*
Spayed/Neutered?*
- Yes
- No
Date of Spay/Neuter

May leave blank if done by previous owner
WEBSITE
Pictures Taken for Website?*
- Yes
- No
Biography Submitted for Website?*
- Yes
- No
ASSESSMENT OF DOG
Physical Information
Appetite*
- Okay
- Problem
Describe Problem
Eyes*
- Okay
- Problem
Describe Problem
Elimination*
- Okay
- Problem
Describe Problem
Skin*
- Okay
- Problem
Describe Problem
Mobility/Stairs*
- Okay
- Problem
Describe Problem
Weight*
- Okay
- Problem
Describe Problem
Other Obvious or Chronic Physical Problems*
- Okay
- Problem
Describe Problem
List Any Prescription Medications Being Given

Click the + sign to add items.
Behavioral Information
Energy Level*
- High
- Moderate
- Calm
- Lethargic
- Combination
Housetraining*
- Reliable
- Unreliable
- Trained but marks
Housetraining Comments
Describe Behavior in the Following Situations
With Crate*
In Cars*
In Crowds*
On Leash*
With Children*
With Men*
With Women*
With Other Dogs*
With Cats*
Loud Noises*
Thunder/Lightning*
Grooming/Being on Grooming Table*
Has the dog exhibited any problem behaviors such as barking/howling when left alone, digging, chewing carpet or furniture, fence jumping, marking? List those that apply.

Click the + sign to add items.
MISCELLANEOUS
Feeding
Brand*
Amount*
Number of Times per Day*
List Any Supplements Being Given

Click the + sign to add items.
Special Issues
- Separation Anxiety
- Needs Socialization Work
- Needs Obedience Taining
- Other (please comment below)
Additional Comments

Save and Continue Later

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King Soopers Cards

In 2024, 194 households triggered over $6,400 in donations to Colorado Pug Rescue. The donations cost them nothing. They simply linked their King Soopers, City Market, or other Kroger loyalty card to Colorado Pug Rescue. A portion of the total transaction amount for every linked card is donated to us. Won’t you join them? For sign up information, please visit www.kingsoopers.com/i/community/community-rewards

Spark Good

Walmart.com customers and Walmart app users can choose to round up their purchase total to the nearest dollar at checkout for a donation to Colorado Pug Rescue through the Walmart Spark Good program. To participate, please sign up and select us here.

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Colorado Pug Rescue

Dog Evaluation form

MEDICAL INFORMATION

Dates of Vaccinations:

WEBSITE

ASSESSMENT OF DOG

Physical Information

Behavioral Information

Describe Behavior in the Following Situations

MISCELLANEOUS

Feeding

Special Issues

King Soopers Cards

Spark Good

Volunteer!

CPR Volunteers