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Adopt a Dog

Dog Pre-Adoption Questionnaire

Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
How many people live in your home?*
How many of them are under the age of 18?*
Ages*
How long have you lived at this address?*
Are you planning to move in the next 2 years?*
List the name and age of the person that will be primarily responsible for the care of the dog.*
What kind of dog are you looking to adopt?
If there is a particular dog you are interested in adopting, please enter the name of this dog below.
Interested in:
Breed
Age
- Puppy
- Adult
- Senior
Size
- Small (up to 20 lbs)
- Medium (20-45 lbs)
- Large (45-75 lbs)
- X-Large (75 lbs and up)
Sex
- Male
- Female
Why do you want a dog?
- As a companion for me / my family
- For my children
- As a companion for another pet
- As a gift
- Other
Please specify other.
On average, how long will the dog be left home during the day?*
- 1-3 Hours
- 4-7 Hours
- 8-11 Hours
- 12-15 Hours
I prefer a dog who:*
- Will enjoy walking on a leash with me.
- Will run/jog/hike with me.
- Requires only enough exercise to do his/her business.
- Will enjoy walking on and off a leash.
- Will exercise him/herself in my yard.
- Will enjoy going to dog parks.
Where will the dog live?*
What outdoor space, if any, is available for the dog?
Type of fence
Height of fence
The expense of owning a dog can vary greatly depending upon its individual needs and your lifestyle. Costs include regular and emergency veterinary care, medications, food, training, flea control, grooming and boarding. To help us recommend the right dog for you, please indicate how much you can comfortably afford to spend each year:*
If you were no longer able to care for the dog, what plans would be made?*
Current Pets
Please describe the pet(s) currently living in your home. Include their name, species/breed and how long you have owned them.*
Details
What is the name and location of the animal hospital that cares for your pets?*
Details
Previously Owned Pets
Describe the pet(s) you have owned within the past ten years. Include their name, species/breed, how long you owned them and what happened to them.*
Details
What is the name and location of the animal hospital that cared for your previous pets?*
Details
Environment
Are there children regularly visiting your home?
- Yes
- No
When it comes to keeping a clean and tidy home, you are:
When it comes to relating to dogs, do you tend to be more:
- Strict, a real leader type of dog owner
- Lenient, a soft, easy going dog owner
The noise/activity level in your home is usually:
Do you live in a:*
Specify Other
Do you own or rent?*
- Own
- Rent
Additional Information
How did you find out about the Humane Society of Westchester?
Veterinarian name
Newspaper name
Internet site
Other

If you’re looking for a new four-legged friend, you’ve come to the right place!

With a variety of dogs and cats available for adoption of all ages, breeds, sizes and colors, you just might find your perfect match!

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Humane Society of Westchester
70 Portman Rd
New Rochelle, NY 10801
914.632.2925

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Thursday: 2pm-8pm

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©2019 Humane Society of Westchester at New Rochelle | Not-For-Profit Organization | Established In 1911