Home Visit Assessment

Your Name

First Last

Your Email

Applicant's Name*

First Last

Appllicant's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Applicant's Email

Applicant's Phone

Which BRIT Brittany(s) are they interested in?

Is their street...

Busy
Quiet
In-between

Is their neighborhood...

Rural
Urban
Suburban

Will anyone else be involved with the care of this Brittany?

Neighbor, family, friend, etc...

Condition & Style of the home

Neat & Clean
Cluttered & Dirty
Ranch Style Home
Multi-level Home
Apartment/Duplex/Condo

Where will the Brittany be kept while alone?

Crate
Loose in the house
In a room
Garage
Backyard/outside
Kennel/Run

Where will the Brittany be kept at night?

Crate
Loose in the house
In a room
Garage
Backyard/outside
Kennel/Run

Is there a pet door to the backyard?

Yes
No

Is the yard fenced?

Yes
No

How tall is the fence?

If applicable

What type of fence is it?

Privacy
Chain Link
Farm
Invisible

What is the condition of the fence?

Secure
Unsecure

loose boards or large gaps = unsecure

How secure is the gate?

Secure
Unsecure

Approximate size of the yard?

Is there a pool?

Does the house have a garage?

No
Yes, with access
Yes, with no access

If yes with access, is the garage safe?

Describe the garage

messy
clean
storage area
kids play area
workshop
private entertainment area

Does the house have a basement?

No
Yes, with access
Yes, with no access

If yes with access, is the basement safe?

Describe the basement

messy
clean
storage area
kids play area
workshop
private entertainment area

Please list names and ages of humans living in home:

Describe the family's lifestyle

ex: sedentary, active, work/away from home hours, etc.

Describe behavior of adults with each other.

ex: aggressive, passive, respectful, rude, nervous, quiet, etc...

Describe behavior of adults with their children

ex: commanding, push-over, annoyed, respectful, patient, etc...

Describe behavior of adults with their pet(s)

ex: commanding, push-over, annoyed, respectful, patient, etc...

Describe behavior of children towards their pet(s)

ex: loving, disrespectful

Please list types, names, and approx. ages of other pets.

Behavior and condition of current dog(s)

BEHAVIOR ex: well behaved, wild/crazy, shy/nervous, aggressive, happy-go-lucky, cautious, ignores. /// CONDITION ex: good shape, overweight, thin

Describe type of collar the dog(s) are wearing.

No collars
Buckle/snap
Martingale
Choker/prong
Visable tags

check all that apply

Do the current pets get along with other dogs?

Yes
No

Would you allow your Brittany to live here?

Yes
No

Do you recommend this family as a BRIT adopter?

Yes
No

Overall observations

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Home Visit Assessment

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