Note: This is a sample worksheet that you can adapt to fit your particular situation.
Adoption Screener’s Worksheet
Date call received________________Date of interview ____________________
Name and address ________________________________________________________________
Phone numbers: Day________________Evening ________________________
Record the prospective adopter’s answers to these questions:
How did you hear about the pet? ________________________________________________________
What type of animal are you looking for? _________________________________________________
Who is the animal for? ________________________________________________________________
Who will be the primary caregiver? ______________________________________________________
Do you have other pets at home? ___ Yes ___ No
If yes: Please tell me about them. ________________________________________________________________
If no, ask: Have you had pets before? _____ If yes: What happened to them?
Do you have children? _____ If yes: How old are they? _____________________________________
Do all members of the household know about and want a new animal?
___ Yes ___ No
If no, please explain: ________________________________________________________________
Do you live in a house, a mobile home, or an apartment? _____________________________________
Do you own your home or are you renting? ________________________________________________
If renting, does your lease allow pets? ___ Yes ___ No
May I call your landlord? ___ Yes ___ No Landlord’s phone _________________
Can I come to your home, to see where the animal will be living?
___ Yes ___ No
How many hours would the animal be alone during the day?
If you’re trying to find a home for a dog:
Does your home have a yard and is it completely fenced? ___________________________________
Will the dog get regular exercise? ______________________________________________________
If you’re trying to find a home for a cat:
Will the cat be an indoor or outdoor cat? _________________________________________________
Would you consider declawing a cat? ___ Yes ___ No
After the interview, record your impressions:
Does the prospective adopter seem responsible? ____________________________________________
Flexible and compassionate? ___________________________________________________________
What is your general impression of this person? (Go with your gut feeling.)
Any doubts that this will be a good home? ________________________________________________________________