San Diego Humane Society and SPCA: Survey - Dog Pre-Adoption Questionnaire

Dog Pre-Adoption Questionnaire

Adopt a canine companion today! Adopting a furry companion has just gotten simpler. Now you can save time by filling out a pre-adoption questionnaire online, before you visit our shelter! Simply complete the questions, click the "submit" button, and your information will be entered into our sytem prior to your visit. You can even check out some of our special animals online. If you don't find the pet you're looking for, we will keep your application on file for 6 months.

If you have any questions, please feel free to call us 7 days a week at (619) 299-7012.

1.

Please enter your personal contact information.

*

Name:

First Required	Middle Required	Last Required

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number:

Yes, I would like to receive e-mail from San Diego Humane Society and SPCA

Email Format:

Yes, I would like to receive postal mail from San Diego Humane Society and SPCA

*2.

Question - Required - Would you like to receive updated information about upcoming SDHS programs and events, including dog classes?

*3.

Question - Required - I want this animal for (please check all that apply)

	Myself
	Family Pet
	Gift
	Companion for Pet
	Working/Farm

*4.

Question - Required - Do ALL the members of your household want a new pet?

5.

Question - Not Required - If not all members of your household want a new pet, please explain.

(Maximum response 255 chars, approx. 5 rows of text)

*6.

Question - Required - How many adults are in your household?

*7.

Question - Required - How many children are in your household?

8.

Question - Not Required - If there are children in your household, what are their age(s)?

*9.

Question - Required - Type of home

*10.

Question - Required - Do you own your own home?

11.

Question - Not Required - If yes, how long have you owned your own home?

12.

Question - Not Required - If you rent, please provide your landlord's contact information below (your landlord will be contacted.)

(Maximum response 255 chars, approx. 5 rows of text)

13.

Question - Not Required - If you own a condo/townhome, have you checked with your homeowners' association regarding their pet policy?

*14.

Question - Required - Are you over 18?

*15.

Question - Required - Are you a student?

*16.

Question - Required - Do any members of your household have allergies specific to animals?

17.

Question - Not Required - If you answered yes, please explain.

(Maximum response 255 chars, approx. 5 rows of text)

18.

Question - Not Required - Do you already have a veterinarian?

19.

Question - Not Required - May we contact your veterinarian for a reference? If yes, please provide your veterinarian's name or practice name and phone number. If no, please explain.

(Maximum response 255 chars, approx. 5 rows of text)

20.

Question - Not Required - Please list current pets residing at your home (include roommates' pets also). Please include pets' breed, name, age, sex, spay/neuter status, # of years owned, and if they live indoors or outdoors.

(Maximum response 255 chars, approx. 5 rows of text)

21.

Question - Not Required - Have you owned any pets in the last five years not listed as current?

22.

Question - Not Required - If yes, please explain their whereabouts.

(Maximum response 255 chars, approx. 5 rows of text)

23.

Question - Not Required - Can your veterinarian verify vaccination history on current or past pets?

24.

Question - Not Required - If no, please explain.

(Maximum response 255 chars, approx. 5 rows of text)

25.

Question - Not Required - Have you relinquished or given away any pets before?

26.

Question - Not Required - If yes, please explain the circumstances involving giving up your pet, i.e. to whom, why, and when.

(Maximum response 255 chars, approx. 5 rows of text)

27.

Question - Not Required - Where will your new pet be kept when you are home?

28.

Question - Not Required - Where will your new pet be kept when you are NOT at home?

29.

Question - Not Required - If kept outdoors, please explain how your pet would be confined (examples might include zip line, fence, etc.)

30.

Question - Not Required - Length of time outdoors:

31.

Question - Not Required - Type of shade provided:

32.

Question - Not Required - Type of shelter provided:

33.

Question - Not Required - In a 24-hour day, how long would the pet be left alone at a given time?

34.

Question - Not Required - Given the possibility of housebreaking training difficulties, please explain your expectations on this tedious and sometimes very frustrating task.

(Maximum response 255 chars, approx. 5 rows of text)

35.

Question - Not Required - Who would ultimately be responsible for the socialization and training needs of your new pet?

36.

Question - Not Required - The adoption of a lifelong animal friend should not be impulsive, but rather a carefully thought out decision, which will ensure a loving, lasting relationship. Remembering that you are applying for a lifetime companion, are you willing to make the investment in both time and finances (up to $1,000 annually) to care for and properly manage your new pet?

*37.

Question - Required - Would you be willing to allow a representative to make a home visit at a mutually agreed upon time?

*38.

Question - Required - How did you find out about the pet you are interested in (or the San Diego Humane Society and SPCA if no specific pet)?