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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
Date of Home Visit
*
Date Format: MM slash DD slash YYYY
Applicant
Applicant's Name
First
Last
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Interviewer
Home Visitor's Name
*
First
Last
Phone
*
Email
*
Enter Email
Confirm Email
Physical
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?
*
Yes
No
Do they live on acreage?
*
Yes
No
Approximately how much?
*
Is there a fenced area attached to the house?
*
Yes
No
Please describe.
*
Is there an invisible fence
*
Yes
No
Note: Rescued dog cannot be left unattended in an invisible fence. Please go over with applicant.
Any additional comments?
Physical Section
Family
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?
*
Yes
No
Everyone should have been present.
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?
Family Section
Expectations
Were the other pets included during the home visit?
*
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?
*
Yes
No
This means introducing outside first.
Do they have cats?
*
Yes
No
Were the cats present?
*
Yes
No
Please describe the cats' reaction to your dog.
*
Any additional comments?
Expectations Section
Family Lifestyle
Are they a busy, active family?
*
Yes
No
Are they the outdoors type family?
*
Yes
No
(i.e., hiking, camping, etc.)
Will they include the Golden in this activity and treat 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
Very important!
Any additional comments?
Family Lifestyle Section
Current Dog
Describe your impression of their dog(s).
*
Dominant
Confident, but not too dominant
Submissive
Any additional comments?
Current Dog Section
Other Comments
Conclusion
Strengths of the home.
*
Please separate each item with a comma. Thanks!
Weaknesses of the home.
*
Please separate each item with a comma. Thanks!
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 it if you would give your thoughts and opinions. Thanks!
Would you feel comfortable leaving your dog with this family?
*
Please think VERY carefully when answering this question.
Additional Comments
This is an as needed section -- not required.
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
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