Home Visit Report

"*" indicates required fields

Date of Home Visit*

Applicant Information

Applicant's Name*

First Last

Address*

Street Address City State ZIP Code

Home Visitor Information

Home Visitor's Name*

First Last

Phone*

Email*

Enter Email Confirm Email

Physical Characteristics

Is the residence as described?*

Please state the differences.*

Describe the home.*

Is the residence on or near a busy street?*

Do they live on acreage?*

Approximately how much?*

Is there a fenced area attached to the house?*

Please describe.*

Is there an invisible fence?*

Please emphasize to applicants that rescued dog cannot be left unattended in an invisible fence.

Any additional comments?

Regarding the physical characteristics of the home

Family Dynamics

Does the family appear to be able to take care of a dog financially?*

Was the entire family present at the home visit?*

Everyone should have been present.

How did the adult family members react to your dog?*

Do they have children?*

How did the children react to your dog?*

Do they appear to be dog savvy?*

Do they have dogs?*

What kind of dog food do they feed?*

Did you discuss difference in quality food and grocery store food?*

Any additional comments?

Regarding the family dynamics

Expectations

Were the other pets included during the home visit?*

How did the other dog react to your dog?*

Did you tell them to introduce a new dog properly?*

This means introducing the dogs outside first.

Do they have cats?*

Were the cats present?*

Please describe the cats' reaction to your dog.*

Any additional comments?

Regarding expectations

Family Lifestyle

Are they a busy, active family?*

Are they the outdoors type family?*

(i.e., hiking, camping, etc.)

Will they include the Golden in this activity and treat him as a true family member?*

Did you discuss the importance of not letting the Golden off leash until he/she has settled into their home and are confident he/she will recall?*

Any additional comments?

Regarding the family's lifestyle

Current Dog

Describe your impression of their dog(s).*

Any additional comments?

Regarding the applicant's current dog(s)

Other Comments

Strengths of the home*

Please separate each item with a comma.

Weaknesses of the home*

Please separate each item with a comma

Rank this home for a rescue dog.*

What type of dog would you recommend for this home?

Although this question is not required, we would appreciate your thoughts and opinions.

Would you feel comfortable leaving your dog with this family?*

A candid response is appreciated.

Additional Comments

What is your recommendation for this applicant?*

If applicable, please share any specific concerns that led you to make this recommendation.

Copy to interviewer

Send me a copy of this report

Name

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