Pre Adoption Questionniare
Name of dog you are interested in
*
Your Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
Town/City
County
Postcode
Home telephone number
-
Area Code
Phone Number
Mobile telephone number
*
-
Area Code
Phone Number
Are you a permanent UK resident
*
Yes
No
Age range of the main carer of the dog
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18-24
25-34
35-44
45-54
55-64
65-70
71-75
76-80
81+
Number of adults 18+ in your household & relationship to you
*
Number of children under 18 in your household and their ages
*
Are there any children who visit the property regularly? If yes, please state their ages
*
Are there likely to be any changes in the near future ?(eg new baby/moving/operations/building work etc)
*
Are you due to go on holiday in the next six months?
*
Yes
No
If yes, what dates and what provisions will you make for the dog (ie dog would go with you/boarding kennels etc)
Is the above address
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House
Bungalow
Flat
Maisonette
Other
If flat which floor?
Is the above address
*
Owned
Rented privately
Council
Housing Association
If rented/Council/Housing Association do you already have written consent to have a dog at the property?
Yes
No
Is there direct access to a private garden?
*
Yes
No
Is the garden securely enclosed?
*
Yes
No
Approx garden size & height of fencing
Do you work?
*
Full time
Part time
Don't work
Retired
Looking for work
Other
Number of days worked per week
Number of hours worked per day including travelling to and from work
How many hours would the dog be left on its own a day, and why?
*
Any medical problems in your family affected by animals ?(ie allergy)
*
Have all members of the household been in contact with dogs?
*
Have you owned a dog before?
*
Yes
No
If yes for how long and what breed/type etc?
Please give details of your experience. ie novice/experienced/used to working with behavioural difficulties etc
*
Have you ever had to part with/rehome an animal you owned before? If yes under what circumstances
*
Please provide details of current pets
*
Are they neutered?
Yes
No
Are they vaccinated?
Yes
No
Have existing animals lived with dogs?
Yes
No
How much daily exercise would you give a dog and where? (eg park/woods/street)
*
Are you prepared to provide appropriate positive training and socialisation suitable for the breed/age/temperament of the dog/puppy?
*
Yes
No
How active are you?
*
Very
Reasonably
Not very
Name and location of your veterinary surgeon
*
Are you prepared to cover the cost of boarding your dog when you are away?
*
Are you prepared to seek veterinary advice on routine vaccinations, worming, and flea control and to cover the cost incurred?
*
Are you in agreement that a pre home visit is carried out?
*
Yes
No
Are you in agreement that a post home visit be carried out?
*
Yes
No
How far are you prepared to travel to meet suitable dogs in our care.
How long have you been looking for a dog, and what drew you to this particular dog?
*
Any other information you would like to add.
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