Peaceful Paws - Home Visit Form
Applicant Infomation
Full Name
*
l
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
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American Samoa
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Montserrat
Morocco
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Namibia
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Netherlands
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Other
Country
Phone Number
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Area Code
Phone Number
Cell Number
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Area Code
Phone Number
E-mail
Name, age, gender of each person in family
*
Any children under 10
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Yes
no
no but visit frequently
no but visit infrequently
no but they do plan to have kids in near future
no but they do plan to have kids in 5+ years
Children in house are
active, running and playing
love dogs, want to engage with my dog all of the time
quiet and shy but don't think they're always like this
quiet and soft spoken
not interested in the dog much
not sure what to do
obnoxious, running and yelling
no kids in the house
How often do they have visitors
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Often, they're the popular house on the block
Often, their kids and thei friends are here daily
sometimes, but not every day or week
rarely, maybe once a month
rarely, maybe a few times a year
Is someone home during the day
yes
no
only on weekends
schedule is variable
How do they interact with their dogs?
*
dogs love them
dogs listen to them
dogs walk all over them
they are obviously dog people
they like their dogs but aren't over the top
they don't pay any attention to the dogs
they are ineffectual with the dogs/interaction is not productive
What issues have they handled with dogs in the past?
*
counter surfing
leash pulling
basic manners
not good with greeting new people
not good with meeting new dogs
separation anxiety
guarding toys/bones from other dogs
guarding toys/bones from people
protective of family
other
none
If needed, please explain any answers here (be detailed, we're counting on you to tell us what you observed)
Pet Information
What age range are they lookng for?
*
based on your conversation, what age range is appropriate for them
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Any other specific likes or dislikes they mentioned
Interested in a specific breed or breeds (please specify)
Interested in a specific dog on the website (please provide name)
interested in
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Male
female
doesn't matter
prefer male but maybe female
prefer female bu maybe male
Would the breed or specific dog they are interested in actually work for them
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Yes
No
depends on specific dog
Would be better with another breed
Suggestion?
Pets they have now (name, type, breed, gender, age, how long have
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Do they currently crate their dogs
Yes
No
No but gate them off in room
no but used to crate when they were younger
Yes, and plan to do so for new dog as well
no but will do so for new dog unil he transitions
How well behaved are their curent dogs?
please check all that apply to current dog #1
happy
energetic
outgoing
friendly
cautious
bark-y
worried
loved
playful
nervous
jumpy/anxious
confident
lo confidence
more dog oriented
more people oriented
only good with people they know
growl-y with strangers
laid back
at ease
quick to adjust
never got comfortable with us
please check all that apply to current dogs #2
happy
energetic
outgoing
friendly
cautious
bark-y
worried
loved
playful
nervous
jumpy/anxious
confident
lo confidence
more dog oriented
more people oriented
only good with people they know
growl-y with strangers
laid back
at ease
quick to adjust
never got comfortable with us
please check all that apply to current dog #3
happy
energetic
outgoing
friendly
cautious
bark-y
worried
loved
playful
nervous
jumpy/anxious
confident
lo confidence
more dog oriented
more people oriented
only good with people they know
growl-y with strangers
laid back
at ease
quick to adjust
never got comfortable with us
please check all that apply to current dog #4
happy
energetic
outgoing
friendly
cautious
bark-y
worried
loved
playful
nervous
jumpy/anxious
confident
lo confidence
more dog oriented
more people oriented
only good with people they know
growl-y with strangers
laid back
at ease
quick to adjust
never got comfortable with us
describe how current pets are treated (check all that apply)
like royalty
very well, dogs are happy
dogs seem worried about being reprimanded
pretty well, part of the family but not central
constantly being told no or bad
Cats
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indoor only
indoor and outdoor
outdoor only
none
How long will dog be left alone without a potty break?
*
Where will dogs be left when alone?
*
Check all that apply
*
Other dogs visit house frequently
Other dogs visit house sometimes
family walks/wants to walk dog in neighborhood
family wants to take dog o dog park
family wants to take dogs with them on hikes/outdoor social events
dog can stay home when family goes to visit
it's OK if other dogs can't visit
Home Information
Is their current home a
*
detached single family
trailer
townhouse
condo
row house/twin
Do they own or rent?
*
Own
rent
House is located
*
country
city
suburb
town
Is their house
*
within 500 ft f neighbors
attached on one side
attached on both sides
people above them and to the sides
people below and to the sides
can't see neighbor
neighbor is close butt there's some space between the two places
Check all that apply
*
small house, little room to turn around
medium sized rooms, with some room to maneuever
large spacious rooms, dogs would have no issues with space
big rooms but full of stuff
house consists of several small rooms, so overall SF is big but rooms aren't
big windows at front of house overlook street activity
crowded
spacious
close to sidewalk
Describe any areas that may be an issue for a dog (space, bay windows, no carpets on stais, lots of breakables)
Set up for New Dog
is the family set up/ready for their new dog?
*
Yes completely
Not completely
Not at all
If needed, explain answer here
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where is the dog's safe space? Is it away from traffic but still close to people? Is it a good spot?
*
The family already has the following for the dog:
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collar/leash
tag
bedding
crate
toys
food
If the family has other dogs, how do they plan to separate? Is this a good option? Was there a better option?
*
If the family has cats, how do they plan to introduce? Is there a way out in every room for the cat where the dog can't follow?
*
Does the family truly understand about the transition period and what to expect? Did you talk to them about it in depth?
*
Yard/Neighborhood
Is property close to main highway or intesection
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yes
no
neighborhood
*
you can see next door neighbor dogs through fence
you can't see any other dogs
very open, active neighborhood
you can see street activity from bckyard
house sits on a corner lot
neighbors are very close and can hear if dog barks inside house
neigbors can hear if dog barks in yard
there are a lot of steps to go from deck to yard
If the dog gets loose, it's not safe
this is countryside , there's nothing but land
this is city, there's nothing but pavement and streets
How big is their yard?
*
Is the yard fenced
*
Yes fully
Yes partially
No
How high is the fence
4 ft
5 ft
6 ft
mixed (please explain)
What type of fence
post and rail-type
privacy
shadow or spaced picket
chicken wire/deer fencing
wrought iron
chain link
If partially or no, or mixed height or type, please describe further.
Swimming pool
*
yes, fenced
yes, not fenced
no
Is the fence secure?
yes, it is possible that a dog could jump (sloped yard, low fence section, etc)
no, the fence is sturdy and over 4 ft
possible, if the dog were an escape artist, but not likely
yes, it's possible that a dog could wiggle out from the bottom
no, no easy way to wiggle/dig out
Summary
Did you discuss the following topics with them
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feeding quality food/feeding natural/raw
3-year vaccination schedule, yearly vet visits
elevated feeding vs non
specific breed traits
specific medical issues
specific dog of interest
transition period
Cost of Caring for Giant breed dane
hazards in house for giant breed dogs (glass tables, knick knacks)
counter surfing
Overall impression
*
Highlights of home visit
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Potential areas to discuss that you found during home visit
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what type of dog will fit best with this home? If they are looking at specific dog, ido you think that dog will work for them? Why or why not?
*
Recommmendation
*
Approve
Approve with Qualifiers
deny
Other
Name of person perfoming home visit
*
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