HOME VISIT REPORT
Fields marked with an * are required
Date of Visit: *
Length of Visit: *
HV Completed by: *
HV completed by email: enter email if you want a copy of this emailed to you
They are applying to: *
Enter name of dog they are interested in (if applicable:
First Name: *
Last Name: *
Phone (home): *
Please describe interior and exterior, is it dog friendly, any concerns?
Rental/Apt is OK for Pet?:
Only answer this question if you they are a renter.
Do they have a fenced yard?:
Tell us about their children, including ages:
(if they reside in household dog will be kept)
Explain how the children interacted with the dog, were they respectful/knowledgeable, etc.
Do they have other pets?: *
Tell us about their other pets (species, breed, age). Enter none if no other pets: *
If they have other dogs, please tell us the breed, gender, age, spayed/neutered for each.
Describe diet plan for their Cavalier *:
Who will be their Cavalier caregiver in an emergency?: *
If they are faced with an emergency, who will care for their Cavalier?
If they travel and cannot take their Cavalier, what plans will they make for its safekeeping?:
Where will their Cavalier be allowed during the day?: *
How many hours a day on average will their Cavalier spend without a human?: *
Accepting of Cavaliers with special needs?: *
Are they willing to accept a Cavalier that has been diagnosed as having a medical need that will require daily medications and frequent visits to veterinarians or specialists?
Where will their Cavalier be allowed to sleep?: *
How many hours a day maximum will their Cavalier spend without a human?: *
Cavaliers in need of training?: *
Are they willing to accept a Cavalier that has behavior problems and might require special training?
Willing to accept neglected or abused Cavaliers?:
Readiness to rescue a Cavalier rating:
Any additional notes from Home Visit Volunteer:
Today's Date: *
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