Star Of Texas - Pet Selection Questionnaire Form

1
Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
3
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
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Egypt
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Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
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Gibraltar
Greece
Greenland
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Guadeloupe
Guam
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Guinea
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Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
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Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
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Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Phone Number
Area Code
Phone Number
5
Part 1: Household Composition
6
Please list people that will live with or interact with the pet routinely. Include name, age, and relationship:
Name
Age
Relationship
1
2
3
4
5
1
2
3
4
5
Name
Age
Relationship
Name
Age
Relationship
Name
Age
Relationship
Name
Age
Relationship
Name
Age
Relationship
1 of 5
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List current household pets including name, age, sex, species/breed:
Pets Name
Age
Sex
Species/Breed
1
2
3
4
5
1
2
3
4
5
Pets Name
Age
Sex
Species/Breed
Pets Name
Age
Sex
Species/Breed
Pets Name
Age
Sex
Species/Breed
Pets Name
Age
Sex
Species/Breed
Pets Name
Age
Sex
Species/Breed
1 of 5
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List any previous pets you have had including name, species/breed, and reason the pet is no longer in the home:
Pets Name
Species/Breed
Reason
1
2
3
1
2
3
Pets Name
Species/Breed
Reason
Pets Name
Species/Breed
Reason
Pets Name
Species/Breed
Reason
1 of 3
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Part 2: Household Logistics and Dynamics
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Is anyone in the home allergic to animals?
Yes
No
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Does anyone in the family have special needs?
Yes
No
12
If yes, please specify
13
How often do adults visit the home?
Daily
Numerous times a week
1 - 4 times a month
Infrequently
14
How often do children or teens visit?
Daily
Numerous times a week
1 - 4 times a month
Infrequently
15
How would you describe your current lifestyle?
Very hectic
Moderately busy/Controllable
Calm/Quiet
16
Are there any major family changes in the near future?
Yes
No
17
If yes, please specify
18
You live (mark all that apply)
in a house
in an apartment or condominium
in a high-rise
on a farm
in an urban setting
in a rural setting
in a suburban setting
19
What is your approximate yard size?
Large (acre or more)
Medium
Small
No yard
20
What type of fencing is around the yard?
21
Part 3: Management and Responsibilities
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How will your pet be managed in the backyard?
Where will your pet spend most of his/her time?
What will your pet’s indoor areas include?
Where will your pet sleep?
23
How long will your pet be left alone during the day (typicalwork day)?
Where will your pet be kept when you are not home?
How much time do you plan on interacting with your pet daily? (training, playing, exercise, grooming, etc.)?
How often do you travel?
24
What will you do with your pet when you travel?
Who will be responsible for feeding?
Who will be responsible for cleaning up after the pet?
Who will be responsible for administering medications?
25
How often do you plan to walk your pet?
Who will be responsible for walking?
How often do you plan to train your pet?
Who will be responsible for training?
26
Do you plan to attend private or group training classes?
Do you plan on crate training your pet?
27
Part 4: Financial Considerations
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How much are you willing to pay for your pet?
How much are you budgeting monthly for pet food?
Do you plan on spaying or neutering your pet?
How much are you budgeting annually on your pet’s medicalcare?
29
Part 5: Pet Characteristics
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Which of the following pet sources are you considering to obtain a pet?
Reputable breeder
Animal shelter/human society
Rescue group
Online resource
Pet store
31
Are there other animals besides your current pets that you anticipate your pet will need to interact with?
32
How often do you plan to groom your pet yourself?
33
Do you plan to have your pet professionally groomed?
34
How important is it to you that your pet “guards your home”?
Very important
Important
Not important
Do not want a guard dog
35
How important is it to you that your pet wants to sit in your lap, follows you around?
Very important
Important
Not important
I would rather have an independent pet
36
How much does hair on your clothing or furniture bother you?
Cannot tolerate
Can tolerate somewhat
Does not bother me
37
Your primary purpose for obtaining a pet
38
What size pet do you prefer?
39
What age would you like the pet to be when you acquire it?
40
Prioritize 3 activities you would like to do with your pet
1.
2.
3.
41
Breeds you are considering
1.
2
3.
4.
5.
42
Are you interested in training your pet?
Yes, I look forward to training
No, I would like a pet that requires little training
43
Potential pet behaviors and your tolerance for them
Behavior I could live with
Would do whatever it takes to address the behavior
Behavior would prompt me to part with the pet
House training problems
Shyness with people Aloofness with family
Excitability
Demands attention
Jumps on people
Digging/yard destruction
Chewing/destructive
Excessive vocalization
House training problems
Shyness with people Aloofness with family
Excitability
Demands attention
Jumps on people
Digging/yard destruction
Chewing/destructive
Excessive vocalization
Behavior I could live with
Would do whatever it takes to address the behavior
Behavior would prompt me to part with the pet
Behavior I could live with
Would do whatever it takes to address the behavior
Behavior would prompt me to part with the pet
Behavior I could live with
Would do whatever it takes to address the behavior
Behavior would prompt me to part with the pet
Behavior I could live with
Would do whatever it takes to address the behavior
Behavior would prompt me to part with the pet
Behavior I could live with
Would do whatever it takes to address the behavior
Behavior would prompt me to part with the pet
Behavior I could live with
Would do whatever it takes to address the behavior
Behavior would prompt me to part with the pet
Behavior I could live with
Would do whatever it takes to address the behavior
Behavior would prompt me to part with the pet
Behavior I could live with
Would do whatever it takes to address the behavior
Behavior would prompt me to part with the pet
1 of 8
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What has prompted you to seek a pet at this time?
45
List any questions or concerns
Should be Empty: