Dog Adoption Survey

First Name:
Last Name:
Zip Code:
Home Phone:
Cell Phone:
Email Address:


If you are seeking a specific pet from our agency, please tell us his or her name and why you would like to adopt him or her:

If you don’t have a specific animal in mind, please tell us about the type of dog who might interest you, so we can recommend a perfect match:

I prefer:

a male   

a female   

no preference

I prefer:

a puppy  

a young adult  



no preference


Of course, they’re adorable. But, if you are interested in a puppy, will you happily work to train your new addition, even when he or she exhibits typical puppy behaviors, such as:

urinating on and soilling the floor or carpet

chewing up shoes, toys and furniture

digging in the yard

barking and yowling through the night

jumping up and scratching your doors, other people and pets

incessantly nipping your fingers and ankles, when teething

Still think you can take it?



This dog will live:

primarily indoors, with outdoor exercise

outdoors as a yard dog

In terms of dog’s breed or appearance,
I would prefer a dog of this description:

I prefer a dog with an energy, activity and/or attentiveness level of this description. Please check all that apply:

very playful and high energy

laid back and easy going

smart, well trained and/or able to learn commands

very affectionate, expressive and responsive

protective of the household

most in need of a home

Please check all that apply.
I want to adopt this dog:

primarily as a pal and companion

to provide security and help protect my family

to primarily serve as a guard dog

to accompany on fishing and hunting trips

to teach my child or children responsibility

as a gift for a loved one or someone special

Please check all that apply.
My dog will:

never ride in my vehicle

occasionally ride in my vehicle

accompany me on trips to the park or store

enjoy riding in the back of my truck

sometimes be left unattended in the vehicle when I run errands

Please check all that apply.
My dog will get his or her exercise:

in my yard

on regular short walks

on a long daily walk

at the local dog park

when my son or daughter walks him
or her

Is there anything else you’d like to tell us about the sort of dog you’d like to adopt?


Do you currently live with pets?


If yes, please describe them. Include details about their species, breed, age and temperment. Also let us know if they are spayed and/or neutered or microchipped.

If you have one, please provide your veterinarian’s name and contact information.

If you have had pets in the past, please tell us about them. Include details about their species, breed, whether or not they were spayed and or neutered and/or microchipped. Also, please let us know if they passed away, if they were lost or something happened to them, or if they are living with someone else at present.

Do you own or rent your place of residence?


If you rent, please provide your landlord’s contact name and information, if we can contact him or her:

Tell us about your family or household. Please include details such as the names and ages of your family membes or housemates, as well as their relationships to you.

Is everyone in agreement to adopt a dog as described above? Yes


I would best describe my home
as a:



Small House

Large House

I would best describe the noise and activity level in my household as follows:




In terms of housekeeping, I would best describe my household as:

Cozy/Lived In

Neat and tidy


If there are any pet behaviors that you or any of your household members will not tolerate, please describe them.

If a new household member arrived at your residence, and that person feared, disliked or was allergic to this pet, what would you do?

If your pet became lost, what would you do to find him or her?

What will you do with your pet, if you are forced to evacuate, as the result of a hurricane or other natural disaster?

If this is an out of state adoption, please indicate the manner in which you would prefer to take custody of the pet:

Sponsor the cost of my pet’s air transportation

Travel to Louisiana to pick up my pet

Accept custody of the pet, when he or she is delivered by the HumaneSociety of Louisiana or cooperating local shelter

If you could not continue to keep this pet for any reason, would you agree to return him or her to us, even if the pet is located in another state at that time? Yes


Are you agreeable a pre-adoption home visit at your residence, before you take custody of this pet. Yes


If you would like our Adoption Counselor to speak with you about any of the following topics, please indicate them:

What to feed my dog and how often

Introducing your new dog to your other pets

Introducing your new dog to other family members

Boarding or other care options for your dog, when you are out of town

Obedience training

Bad habits, such as jumping up, counter surfing, scratching furniture, etc.

Is there anything else you would like to discuss with us concerning this adoption?

Thank you SO much for taking the time to
complete this survey!!

An Adoption Counselor will be in touch with you soon.
We’ll do our best to match you with the perfect dog,
who best suits your lifestyle and would thrive in your household.