Small and Exotic Animal Questionnaire - Sacramento SPCA

Sacramento SPCA – Let’s Get AcquaintedSmall Animal & Exotic AdoptionHow did you hear about us?Date__Website __TV __ Newspaper __ Friend/Family __ Penny Saver ___ OtherName Address City/State/ZipHome Phone Work Phone Cell phoneAre you 18 years of age or older? Drivers License or ID/Expiration Email AddressWe are committed to reducing pet overpopulation and spay/neuter all pets before they go home.You and Your HouseholdTime away from home: Living situation:Home lifestyle: Home all day Rent Very Active Out part timeLandlord :______________ Active Away 7-10 hrs/day Phone:_________________ Somewhat Active Other __________ Own Calm and quiet Live w/ Parents Mobile Home Reason for adopting: Condo Family CompanionChildren and your home: For My Children I have children; ages _______________ Gift for Someone I do not have children Companion for Pet Children visit my home; ages ______________ Other ___________ Children rarely visit my homeHistory and PreferencesPlease check all that applyRabbit, Rodent, Bird, Reptile First Time Owner Have Had One or Two Have Had ManyWhat will you spendyearly for the care ofyour pet? (food, medical,boarding, toys, licensing,grooming, scratchingposts, etc.)$___________________Please check all that applyType of pet(s) I like:____________________________________________________Type of pet(s) I do not want:____________________________________________________Coat type preferred: Short Medium Long No preference Shedding (circle below)Low Medium HighSex: Male Female No preferenceDuring the day my pet will be (check box): Inside – confined Inside – roaming freely Outside – confined Outside – roaming freelyAt night my pet will be (check box): Inside – confined Inside – roaming freely Outside – confined Outside – roaming freelyAge: Baby Young adult Adult Senior Special needs _____________________ No preferenceCheck ALL personality traitsyou want OR could accept: Very independent High energy Calm, relaxed Somewhat friendly Very friendly Affectionate Playful Gentle, well mannered CalmIs anyone in yourhousehold allergic to: Cats Dogs Other ________________

Behavioral TraitsCURRENT & PREVIOUS Pets (write in letter[below] that best describes how each behaviorwas dealt with):A = Accepted (didn’t matter)B = Crated/confinedC = Trained myselfD = Left pet outside/kept outsideE = Didn’t keep petF = Other ___________________ Vocal/Noisy__ Hyperactive/too excitable__ Biting/scratching people__ Aggressive w/unknown pets__ Aggressive w/familiar pets__ Plays roughly__ Hides occasionally__ Hides oftenUnacceptable behavior toward people: Very active/very playful Unfriendly or fearful toward adults Unfriendly or fearful toward children Aggressive – may bite or scratch Independent – doesn’t really need people muchUnacceptable behavior toward animals: Friendly or ignores Unfriendly toward another pet May attack another pet Gets along with your pets but not unknown pets Afraid of other animals – backs awayPets Living with you PAST and PRESENT(Please list all in the past 10 years)Pet’s Name Age Sex Breed/Type Altered?How LongOwned?Kept In, Out,BothStill Have?If No, Why?FOR OFFICE USE ONLYCase # _____________________Counselor’s Name:_______________________________________________________Hold Pending: Other Adults Children Other:_______________________________________________________________Required topics covered with counselor: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________I have been made aware of and understand the information written and checked by the counselor and have chosen to adopt this pet.____________________________ PRINT (adopter) _____________________________ SIGN (adopter) ______________ (date) Personality Traits Activity level Introductions Children Health Care/Cost Reason For Wanting Previous Pets Indoor/Outdoor Destruction Breed Allergies Spaying/Neutering Biting/Scratching SPCA Behavior Helpline (free) SPCA Retail StorePet Request: Landlord Contacted/Policy ______________________________ Paid $15 Date _____ Renewal ($15) Date ______Pre-counseling completed/Counselor: ____________________ Pre-counseling notes: __________________________________________________________________________________________________________________________________________________Date: _______ Animal Details: ____________________________________________________ Outcome: _______________________Date: _______ Animal Details: ____________________________________________________ Outcome: _______________________Date: _______ Animal Details: ____________________________________________________ Outcome: _______________________