Hospice Adoption Questionnaire

Thank you for considering being a hospice parent! Please answer the following questions so that we can make a great match for you and your mutt! Contact us if you have problems or questions in filling out this questionnaire.

General Information

Are you a veteran?    
Are you 62 years or older?    

What Brought You To Muttville

How did you hear about Muttville? Check all that apply.
What relationship does this person have to Muttville? Check all that apply.
Which one(s)?
What kind?

Your New Dog

Have you ever had a dog before?    

Living Situation

Please provide your birthdate and the name, age, and relationship to you of each adult occupant of your home:
2nd adult occupant

3rd adult occupant

4th adult occupant

Do you have stairs inside or leading into your home?    
Will you allow us to visit your home?    

Current Animals in Your Home

Do you currently have other pets?    

Animal Care Experience

Do you have experience dealing with behavioral issues?    
Do you have experience administering medications?
Eye medications?               Oral medications?               Injectables?    
Some hospice dogs may need the above care. Are you willing to learn how and give it a try?    

Additional Comments



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