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:
TYPE PET |
SEX |
AGE |
SPAYED/ NEUTERED |
WHERE PET STAYS |
CAT |
DOG |
OTHER |
M |
F |
|
YES |
NO |
INSIDE |
OUTSIDE |
IN & OUT |
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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. |