Appointment-Based Adoption Questionnaire

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What animal are you interested in adopting? Please type the pet’s name and include the pet’s 6-digit Animal Code number.

Pet Name

Animal Code*

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Are you interested in adopting two cats? If so, please enter another cat's Animal Code number here.

We cannot guarantee you will meet this second cat, but will make every best effort to accommodate your request. The Animal Code can be found on the pet’s profile page under its name and in the sidebar as “Code #”.

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Are you able to take your new pet home within 24 hours of submitting your questionnaire?

Most invitations for meet and greets are sent within 24 hours after your adoption questionnaire is submitted. If you are not first, it can take up to 72 hours to receive an invite. Pets are expected to go home at the time of your adoption appointment. We cannot accommodate holds on any animals beyond the adoption appointment.

What is your date of birth?*

You must be 18 years or older to adopt.

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indemnity_value

Are you able and willing to bring your resident dog to the shelter to meet this dog?*

Are you willing and able to adopt a blind pet?*

Are you willing and able to adopt a cat which has been tested to indicate it may be FeLV positive?*

Are you willing and able to adopt a cat which is FeLV positive?*

Are you willing and able to adopt a cat which may be prone to urinary crystals/blockages?*

Are you willing and able to adopt a cat which requires long-term medical management for asthma?*

Are you willing and able to adopt a deaf pet?*

Are you willing and able to adopt a FIV postive cat?*

Are you willing and able to adopt a pet which may require future eye surgery?*

Are you willing and able to adopt a pet which may require long-term medical management?*

Are you willing and able to adopt an animal which will require long-term medical management?*

Are you willing and able to adopt a pet which may require medical follow-up?*

Are you willing and able to adopt a pet which will require medical follow-up?*

Are you willing and able to adopt a pet which may require ongoing cardiac assessment?*

Are you willing and able to adopt a pet which may require surgical intervention?*

Are you willing and able to adopt a pet which will require long-term medical management?*

Are you willing and able to adopt a ringworm positive cat and continue treatment in your home?*

Are you willing and able to adopt a ringworm positive dog and continue treatment in your home?*

Are you willing and able to adopt a ringworm positive guinea pig and continue treatment in your home?*

Are you willing and able to adopt an animal that is heartworm positive?*

Are you willing and able to adopt an animal that may require future orthopedic surgical intervention?*

Are you willing and able to adopt an animal which may require long-term management for arthritis?*

Are you willing and able to continue the treatment for demodedectic mange?*

This is not a contagious disease to other animals or humans.

Are you willing and able to continue treatemnt for sarcoptic mange, which is contagious to humans and other animals?*

Are you willing and able to provide a dental cleaning with potential for extractions?*

Are you willing and able to provide dermatological care for this pet?*

Are you willing and able to provide insulin injections to a diabetic cat?*

Are you willing and able to provide insulin injections to a diabetic dog?*

Are you willing and able to provide physical rehabilitiation to this animal?*

Are you willing to adopt an animal that has proven to be high energy?*

Are you willing to adopt an animal that has been known to exhibit resource guarding behavior either toward humans and/or other animals?*

Are you willing to adopt an animal that has been known to be shy and/or nervous?*

Are you willing to adopt an animal that has a history of escaping the home/property?*

Are you willing to adopt an animal with a known bite history to a human?*

Are you willing to adopt an animal with known housetraining struggles?*

Do you have a secure, fully-fenced yard?*

Do you currently have a cat(s) living in the home?*

Do you have a resident cat(s) already in the home or are you interested in adopting two cats together?*

Do you currently have a dog(s) living in the home?*

Does your new dog have to be good with other animals?*

Have you read the What to Expect handout?*

Do you live in an adult only home?*

Have you been the sole caretaker for a dog as an adult?*

Have you been the sole caretaker for a cat as an adult?*

Do you live in an apartment or condo-type home?*

I'm interested in the Diamond in the Ruff program for this pet and I have read the information.*

Adoption Questionnaire

Salem Campus

Community Veterinary Hospital

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