SICSA · Dog Pre-Adopt Questionnaire

Name

*

First Name

Last Name

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Primary Phone

*

Alternate Phone

Email

*

Verify Email

*

Are you 18 years old or older?

*

Yes

No

Dog Preferences & Matching

Our trained adoptions counselors will help find the right fit for you!

Have you already selected a dog in which you are interested in adopting?

*

Yes

No

Dog's Name

*

Household Information

Do you:

*

Rent

Own

Live with Family

Rent-to-Own

Other

How many other people live in your home?

*

Name

*

First Name

Last Name

Age

*

Name

*

First Name

Last Name

Age

*

Name

*

First Name

Last Name

Age

*

Name

*

First Name

Last Name

Age

*

Name

*

First Name

Last Name

Age

*

Pet Information

How many total dogs and/or cats live in your home?

*

Pet #1

Dog

Cat

Pet's Name

Breed

Age

Is this pet fixed?

Yes

No

Pet #2

Dog

Cat

Pet's Name

Breed

Age

Is this pet fixed?

Yes

No

Pet #3

Dog

Cat

Pet's Name

Breed

Age

Is this pet fixed?

Yes

No

Pet #4

Dog

Cat

Pet's Name

Breed

Age

Is this pet fixed?

Yes

No

Do you have more than 4 dogs and cats and you ran out of space? No problem, tell us about them in person!

Yes

No

Do you have other pets who are not cats or dogs?

Yes

No

Veterinary Information

I currently have a veterinarian.

I do not currently have a veterinarian, but would like to discuss options.

Veterinary Clinic Name

Learning More

We will explain a dog's medical and behavior history, but please check any other topics you'd like to discuss. There are five categories below: Home, Handling, Health, Happiness, and Other. Check as many boxes as you'd like!

Home

House-training

Crate-training

Acclimating your new dog to your home

Acclimating your new dog to other pets

Children and pets

What to expect the first couple of months

Handling

Finding a trainer

Leash walking

Mouthing

Inappropriate jumping

Health

Feeding

Grooming & nail trimming

Finding a Veterinarian

Parasite prevention

Annual vet care

Happiness

Exercise

Toys and fun activities for your dog

Appropriate treats

Available items in our gift shop

Other

I'm a first-time pet owner

Any other questions? Or is there anything you want us to know that we haven't asked?

Electronic Signature

*

I have answered all of the questions truthfully and to the best of my knowledge.

I agree

Please note

If you are not taken to a confirmation page after clicking submit, please check above for fields missing information. Thank you!