Home Visit - AHeinz57 Pet Rescue and Transport

Please fill out this form for applicants considering to adopt from AHeinz57.

Date*

Dog*

Applicant*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Type of residence*

Is the neighborhood safe and well kept?*

Yes
No

Street description*

Very busy
Moderately busy
Quiet
Rural/country
Suburban
Urban city

Exterior residence condition*

Well kept
Un-kept
Needs repairs
Being remodeled

Yard condition*

Maintained
In need of work
Debris
Hazards

Is there a swimming pool?*

No
Yes - it is secure
Yes - it is not secure

Is there a dog run or kennel?*

Yes
No

Is there evidence of a dog tie out?*

Yes
No

Is there a balcony?*

No
Yes - it is enclosed
Yes - it is not enclosed

Does the property have a fence?*

Yes
No

If yes to a fence, what is the fence height?*

Condition of fence*

Solid and secure
In need of repair

Does it enclose the entire yard?*

Yes
No

Type of fencing*

Wood
Chainlink
Farm fence
Invisible

Is the fence secure against the ground?*

Yes
No

Number of fence gates*

Are there locks on the gates?*

Yes
No

If there are locks, will they be used?*

Yes
No

Interior residence condition*

Needs minor repair
Needs major repair
Clean and neat
Clean and well lived in
Messy and untidy
Unclean and dirty
Unfit for human or animal

Is there a basement?*

Yes
No

Basement condition*

Finished
Unfinished
Remodeling

Will the dog have access to the basement?*

Yes
No

Basement condition*

Needs minor repair
Needs major repair
Clean and neat
Clean and well lived in
Messy and untidy
Unclean and dirty
Unfit for human or animal

Are there hazards in the basement?*

No hazards
Yes - in reach
Yes - out of reach

Is there a garage?*

Yes
No

Garage condition*

Needs minor repair
Needs major repair
Clean and neat
Clean and well lived in
Messy and untidy
Unclean and dirty
Unfit for human or animal

Are there hazards in the garage?*

No hazards
Yes - in reach
Yes - out of reach

Will dog have access to garage?*

Yes
No

Are there other pets in the home?*

Yes
No

Temperament of current pets*

Fearful
Submissive
Friendly
Outgoing
Well behaved
Aggressive

How were you greeted by the pets?*

Well behaved
Excited but controlled
Out of control

Do the pets appear healthy and well-cared for?*

Yes
No

Does the family understand that sometimes rescue animals go through a period of adjustment?*

Yes
No

Is the family willing to take the time it may require for the adjustment period?*

Yes
No

Does the family have a basic understanding of a rescue dog's needs, behaviors and possible fears of certain adults and children?*

Yes
No

Is the family prepared to feed the dog high quality dog food (www.dogfoodadvisor.com or www.dogfoodanalysis.com)?*

Yes
No

Is the family prepared for accidents in or damage to the home during the adjustment period?*

Yes
No

Does the family have arrangements for the dog when they go out of town?*

Yes
No

Is the family prepared for possible issues with their current pets?*

Yes
No

Do you think the applicant will provide a good, loving home?*

Yes
No

Will this home keep the dog's needs in mind?*

Yes
No

Will this home provide for the dog's safety at all times?*

Yes
No

Are there any special needs, unusual circumstances or concerns that AHeinz57 should consider? Explain here.*

Home visit completed by*

Your name

Home visit requested by*

Additional notes