Family Dog Aftercare

About You

First Name*

Surname*

Email address*

Town*

County*

About your child

Child's First Name*

Child's Surname*

Child's Gender*
—Please choose an option—MaleFemale

Child's Diagnosis*

Date of Diagnosis*

Family Details

Please list all household members below.

Dog Details

Do you currently have a dog?
—Please choose an option—YesNo

Dog's name

Dog breed

Dog gender

Dog date of birth

Where did you get your dog from?
—Please choose an option—ADUKBreederFriend or FamilyNewspaper AdvertRescue CentreWebsiteOther - please detail

If selected other, please detail here:

Additional dogs - Please detail any other dogs in the household.

Where did you hear about us?

Please let us know how you heard about us.
—Please choose an option—Social MediaInternet searchPressDogs for GoodOther assistance dog charityDog training professionalHealth professionalSupport group/schoolFriendWorkshop attendeeDog rescue centre

Keeping you updated

As well as information about our Family Dog service, we would also like to email you to tell you about our great work and how you can support us. Please let us know if you would like to receive these updates.
Yes please

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