Pet Adoption Questionnaire:
A Screening Tool To Help Individuals and Organizations Pick the Best Homes for Cats, Dogs and Other Household Pets.

PET PRE-ADOPTION QUESTIONNAIRE
©1996 ALABAMA PET REGISTRY, INC.

For a printable version of this document, click here

1) WHY DO YOU WANT TO ADOPT A/THIS PET? (Choose only one)
    A, Companion for another pet: ___  B, Companion for self: ___ 
    C, Protection: ___  D, Gift: ___ E, Surprise Gift: ___ 
    F, Watchdog: ___ G, Replacement Pet: ___
    H, To Breed: ___ I, To Sell: ___ J, To Hunt: ____

2) HOW MANY PEOPLE LIVE IN THE HOUSEHOLD?
    Number: ___ 

3) THE NUMBER OF PEOPLE BY AGE CATEGORY WHO LIVE IN THE HOUSEHOLD? 
    A, Adults (19 to 65) ___  B, Seniors (Over 65) ___ 
    C, Adolescents (12 to 18) ___   D, Children (3 to 12) ___ 
    E, Infants (Under 3yrs.) ___ 

4) HOW WOULD YOU RATE YOUR GENERAL KNOWLEDGE OF THE TYPE PET YOU ARE INTERESTED IN ADOPTING?
    A, Very Knowledgeable: ___ B, Somewhat Knowledgeable: ___ 
    C, Little or No Knowledge: ___

5) HOW LONG HAVE YOU BEEN ACTIVELY LOOKING FOR A NEW PET?
    (Choose only one)
    A, No. of Days :___ B, No. of Weeks: ___ C, No. of Months: ___

6) WHAT HAVE YOU DONE TO PREPARE FOR ONE?
    _____________________________________

7) ARE THERE OTHER PETS IN THE HOUSEHOLD NOW?
    A, Yes: ___ B, No: ___

8) IF 7 "YES" ABOVE IS CHECKED, PLEASE PROVIDE THE FOLLOWING INFORMATION:

9) IF THERE ARE NO PETS IN THE HOUSEHOLD NOW, HAVE YOU OWNED ANY PETS BEFORE? 
    A, Yes: ___ B, No: ___

10) IF YOU OWNED PET(s) BEFORE WHERE IS HE/SHE/THEY NOW?
    A, Don't Know: ___  B, Gave Away: ___  C, Lost, Never Found: ___ 
    D, Died: ___  E, Sold: ___  F, Never Owned: ___ 
    Explanation: _____________________________________

11) IF ANY PETS DIED IN THE LAST 12 MONTHS, WHAT WERE THE CIRCUMSTANCES?
    A, Old Age: ___  B, Accident: ___  C, Illness: ___  
    D, Disease: ___ E, Don't Know: ___  F, No Deaths: ___
    Explanation: _____________________________________

12) NAME/ADDRESS OF VETERINARY CLINIC USED BEFORE:
    _____________________________________

13) NAME/ADDRESS OF VETERINARIAN OR CLINIC TO BE USED FOR THE NEW PET:
    _____________________________________

14) WHERE WILL THE NEW PET SPEND MOST OF HIS/HER TIME?
    A, Inside: ___ B, Outside: ___ C, Inside & Outside: ___ D, Don't Know: ___

15) WHERE WILL THE NEW PET STAY WHEN NO ONE IS HOME?
    A, Inside: ___ B, Outside: ___ C, Don't Know: ___

16) DESCRIBE THE PET'S OUTSIDE ENVIRONMENT: (Type shelter, fenced yard, etc.)
    _____________________________________

17) ON AVERAGE, HOW MANY DAYS A WEEK WILL THE PET BE LEFT ALONE?
    1 ___ 2 ___ 3 ___ 4 ___ 5 ___ 6 ___ 7 ___

18) ON AVERAGE, HOW MANY HOURS A DAY WILL THE PET BE LEFT ALONE?
    A, 0 to 3 hours: ___ B, 4 to 8 hours: ___ C, Over 8 hours: ___

19) HOW LONG DO YOU INTEND TO KEEP THE PET?
    _____________________________________

20) HOW AND WHERE WILL THE PET BE EXPECTED TO RELIEVE HIM/HERSELF?
    A, Inside, On Own: ___ B, Outside, On Leash: ___ 
    C, Outside, Fenced-In Area: ___  D, Outside, Tied/Chained: ___ 
    E, Outside, Other: ___ F, Don't Know: ___

21) IF A TOILET SCHEDULE IS NECESSARY, WHEN WILL THE PET BE ALLOWED TO RELIEVE HIM/HERSELF?
    A, Whenever Pet Signals to Owner: ___ B, Every Few Hours: ___ 
    C, At Certain Times a Day: ___ D, Don't Know: ___ E, Not Applicable: ___

22) WHAT AGE GROUP WILL HAVE PRIMARY RESPONSIBILITY FOR HOUSEBREAKING THE PET? 
    A, Adult (19 and older): ___ B, Adolescent (12 to 18): ___ 
    C, Child (Under 12): ___    D, Not Applicable: ___

23) HOW MANY PERSONS WILL BE RESPONSIBLE FOR HOUSEBREAKING OR TRAINING THE PET? 
    A, 1 Person: ___ B, 2 Persons: ___ 
    C, 3 Persons: ___ D, 4 or More Persons: ___

24) WHO WILL BE FINANCIALLY RESPONSIBLE FOR THE PET?
    A, Self/Adult: ___ B, Self/Minor: ___ C, Spouse: ___ D, Parent/Guardian: ___

25) HOW MUCH MONEY WILL YOU BUDGET FOR THE PET'S CARE EACH MONTH?
    A, $5 to $10: ___ B, $11 to $20: ___ C, $21 to $30: ___ 
    D, $31 to $40: ___ E, $41 and Over: ___ F, Don't Know: ___

26) IS YOUR RESIDENCE IN THE...?
    A, City: ___ B, Town: ___ C, County: ___ D, Don't Know: ___

27) YOUR RESIDENTIAL AREA IS DESCRIBED AS...?
    A, Urban (City): ___ B, Suburban: ___ 
    C, Rural (Country): ___ D, Don't Know: ___

28) TYPE RESIDENCE:
    A, Single Family: ___ B, Duplex: ___ C, Apartment: ____ 
    D, Condominium: ___ E, Townhouse: ___ F, Mobile Home: ___ 
    G, Rooming House: ___ H: Dormitory: ___

29) LENGTH OF TIME LIVING AT THIS ADDRESS?
    A, Less than 1 year: ___ B, 1 to 3 years: ___ C, Over 3 years: ___

30) OWN OR RENT THE HOME YOU LIVE IN?
    A, Own: ____ B, Rent: ___

31) IF RENTING, WHAT ARE THE PET REGULATIONS? (Security deposits, number & size limits, e.g.)
    A, _____________________________________
    B, Not Applicable: ___

This is the Questionnaire part of APR's Pet Pre-Adoption Screening System (PASS). The Values and Scoresheet complete the system but you must contact APR to obtain them. There may be a small charge. Once you have the password, click here, to download the Values and Scoresheet documents.