Pet Adoption Home Visit Assessment
Applicant Information
Name
Address
Contact Number
Email
Home Visit Details
Date of Visit
Assessor Name
Household Information
Type of Residence
House
Apartment
Condo
Other
Ownership
Own
Rent
Other
If renting, is pet ownership permitted?
Yes
No
N/A
Fenced yard?
Yes
No
Not applicable
Household members and ages
Other pets in household
Home Environment
Cleanliness and tidiness
Pet hazards observed
Pet Care Knowledge
Understanding of pet needs
Plans for exercise/stimulation
Plan for veterinary care
Assessment Summary
Suitability for adoption
Suitable
Suitable with conditions
Not suitable
Conditions/Recommendations
Additional Comments