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Home Visit Report
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Home Visit Report
Home Visit Report
Austin
2019-11-16T16:51:27-06:00
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*
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Date of Home Visit
*
MM slash DD slash YYYY
Applicant Information
Applicant's Name
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
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California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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Hawaii
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Maryland
Massachusetts
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Mississippi
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Montana
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New Hampshire
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New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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?
*
Yes
No
Please state the differences.
*
Describe the home.
*
Spotless - can eat off of the floor
Normal - clean, but looked lived in.
Totally chaotic
Is the residence on or near a busy street?
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Yes
No
Do they live on acreage?
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Yes
No
Approximately how much?
*
Is there a fenced area attached to the house?
*
Yes
No
Please describe.
*
Is there an invisible fence?
*
Please emphasize to applicants that rescued dog cannot be left unattended in an invisible fence.
Yes
No
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?
*
Yes
No
Was the entire family present at the home visit?
*
Everyone should have been present.
Yes
No
How did the adult family members react to your dog?
*
Approached willingly
Reluctant to approach
Would not approach
Afraid
All over the dog in a negative way
Do they have children?
*
Yes
No
How did the children react to your dog?
*
Approached willingly
Reluctant to approach
Would not approach
Afraid
All over the dog in a negative way
Do they appear to be dog savvy?
*
Yes
No
Do they have dogs?
*
Yes
No
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?
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Yes
No
How did the other dog react to your dog?
*
Approached willingly
Reluctant to approach
Would not approach
Afraid
All over the dog in a negative way
Did you tell them to introduce a new dog properly?
*
This means introducing the dogs outside first.
Yes
No
Do they have cats?
*
Yes
No
Were the cats present?
*
Yes
No
Please describe the cats' reaction to your dog.
*
Any additional comments?
Regarding expectations
Family Lifestyle
Are they a busy, active family?
*
Yes
No
Are they the outdoors type family?
*
(i.e., hiking, camping, etc.)
Yes
No
Will they include the Golden in this activity and treat him as a true family member?
*
Yes
No
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?
*
Yes
No
Any additional comments?
Regarding the family's lifestyle
Current Dog
Describe your impression of their dog(s).
*
Dominant
Confident, but not too dominant
Submissive
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.
*
Best
Very good
Good
Unacceptable
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?
*
Approved
Needs further review
Denied
If applicable, please share any specific concerns that led you to make this recommendation.
Copy to interviewer
Send me a copy of this report
Comments
This field is for validation purposes and should be left unchanged.
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