cat
adopter
survey
dog adopter survey
dog adopter survey

first name
last name
date

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
address
city
state
zip

home
( owned) a dog -before.
work phone
) NO email
1phone
I have
YES (
I haveconsider
owned a dog
1 12I would
mybefore.
household
The last time I had a dog was...
to be like
2
The last time I had a dog was...
4
My dog needs to be good with:
Middle of
the road
YES
2-10 years ago
NO
10 years +
2-10 years ago
10 years +
A library
Currently
own dog(s)
Not
currently,
Currently
but dog(s)
within
own
the past year
Not currently,
but within
YES year
the past
A carnival
dog needs to get
along
NO
2 3I amMy
comfortable
with
a cat that
with other dogs.
yes, list names,
and breeds: ______________________________________
likesMytodogplay
“chase my ankles” If_____________________________________________________________________________
No ages, genders
Somewhat
Yes
3
needs to get along
NO
YES
other dogs.
andwith
similar
games
If yes, list names, ages, genders and breeds: ______________________________________
(circle
that to
apply)
3 I want
myall cat
interact with
4guests
My dog
needs
to beto
good
that
come
mywith:
house
(circle all that apply)
Children over
Children under
Cats
_____________________________________________________________________________
8 years old
8 years old
Animals other
Elderly People
than
dogs
Children over
Children under
Cats
and cats
8 years old
8 years old
Animals other
Inside dog
Outside
dog
Elderly People
than dogs
and cats
Little of
the time
will feel
primarily
be an....
Love them but
4 5HowMydodogyou
about
a
rather
not to
thatwillgets
6boisterous
How manycat
hours
your into
dog spend outside
per day?
5
My dog will primarily be an....
Inside dog
everything?
live with them
7
6
My dog needs to be able to
4 hours or less
How
many
hours
will your dog spend outside per day?
be alone
(per
day)...
5 My cat needs to be able to
7
My dog needs to be able to
adjust
toI’m
new
situations
quickly
be alone
(per
day)...I want my
8
When
at home,
dog to be by my side....
6 I want my cat to love being with
8
When
I want
9
When I’m
I’m at
nothome,
at home,
mymy
dog
children
home
dog
toin
bemy
by
side....
will spend
hermy
time...
10
9
When I’m not at home, my dog
will spend her time...
I want a guard dog.
11
10
I want my dog to hunt or herd
me.
Iwith
want
a guard dog.
Some of
the time
All of the
time
Depends on
the situation
Fine by me
8-10 hours
________ hours
Outside dog
2 hours or less
4-8 hours
Not important8-10 hours
Somewhat
12 hours
________ hours
Yes
4 hours or less
2 hours or less
All of the time
Some of the time
4-8 hours
12 hours
Little of the time
It’s not
Little of the time Loose in the house
In the garage
SomeSome
of of the time Most
of
Children do not
important All of the time
In the yard
In a crate in the
Conned to one
the time
the time
often
come
to
whether
my cat
house
room
in
In the
garage
Loose
in the
the house
house
In the yard
myYES
house
loves
with
NO being
In a crate
in the
Conned
to one
house
room in the house
children
NO
YES
NO
YES
12
11
want my
my dog
dog to
to hunt
be the
II want
ortype
herdthat
NO
YES
is
very
enthusiastic in the way
Not at all
Somewhat
Very
with
me.
she shows she loves people.
12
I want my dog to be the type that
13
Iiswant
dog to be in
playful.
Not at
at all
all
Somewhat
Very
verymy
enthusiastic
the way
Not
Somewhat
Very
she shows she loves people.
14
I want my dog to be laid back.
Very
Somewhat
Not at all
13
I want my dog to be playful.
Not at all
Somewhat
Very
15
I am comfortable doing some
with
to improve
14
Itraining
want my
dogmy
to dog
be laid
back.
Very
Somewhat
Not at all
manners such as jumping,
No training
Some training
A lot of training
food, anddoing
pulling
on
15
Istealing
am comfortable
some
the
leash.
training
with my dog to improve
manners such as jumping,
No training
Some training
A lot of training
16
Istealing
(or my children)
to on
food, andwant
pulling
participate
in
Agility,
Flyball
NO
YES
the leash.
or Obedience with our dog.
16
I (or my children) want to
17
Iparticipate
am interested
in a dog
in Agility,
Flyball
NO
YES
with
“special needs”
NO
YES
or Obedience
with our dog.
(medical or behavioral)
17
I am interested in a dog
18
It’s
important
to me that my dog _____________________________________________________________________________
withmost
“special
needs”
NO
YES
(medical or behavioral)
FOR OFFICE USE ONLY
18
It’s most important to me that my dog _____________________________________________________________________________
7 My cat needs to be able to
be alone
More than 9
hours per day
4 to 8 hours
per day
Less than 4
hours per day
8 When I am at home, I want
my cat to be by my side or in
my lap
Little of
the time
Some of
the time
All of
the time
9 I want my cat to enjoy being
held
Little of
the time
Some of
the time
Most of
the time
10 I need my cat to get along with
(circle all that apply)
11 My cat will be
Dogs Cats
Birds Other
Inside
Inside and
Outside
Outside



FOR OFFICE USE
ONLY
 
12 I have lived 
with cats before
Yes
No
Currently


We reserve the
right to deny
any adoption.
Discussion questions for staff use:
Current pets: (age, gender, breed, s/n, owned how long, confinement, medical/behavioral needs)
Past pets: (age, gender, breed, s/n, owned how long, history, disposition)
Living arrangements?
Cohabitants?
Guardianship topics: adjustment
training
classes
exercise
Survey summary:
Animal matches:
play
introduction health cost insurance grooming
socialization toys
confinement
identification
Date:
Initials:
Animal counsel completed
Visit complete
(Date & Initials)
(Date, Initials, Notes)
(Name & Last 3 digits)
Compatability notes:
Hold for:
(Check all that apply)
visit w/ _________
landlord
dog intro
surgery (date)
pending medical
preparation
Completed by:
(Initials)
PO Box 1037, 15305 44th Ave W, Lynnwood, WA 98046 | p: 425.787.2500
f: 425.742.5711 | paws.org
Hold notes:
Revised Jan 2013 2 of 2