Adoption Questionnaire OHS Adoption Questionnaire Please fill out this brief questionnaire so that we can help you find the purrfect furry friend! What animal are you interested in adopting? Please type the pet’s name and include the pet’s 6-digit Animal Code number.Pet Name Animal Code Are you able to take your new pet home within 24 hours of submitting your questionnaire?*YesNoMost invitations for meet and greets are sent within 24 hours after your adoption questionnaire is submitted. If you are not first, it can take up to 72 hours to receive an invite. Pets are expected to go home at the time of your adoption appointment. We cannot accommodate holds on any animals beyond the adoption appointment.What is your date of birth?* MM slash DD slash YYYY You must be 18 years or older to adopt.Hiddenindemnity_valueAre you able and willing to bring your resident dog to the shelter to meet this dog?*YesNoIf you do not have a dog in the home, please respond with “Yes.”Are you willing and able to adopt a blind pet?*YesNoAre you willing and able to adopt a cat which has been tested to indicate it may be FeLV positive?*YesNoAre you willing and able to adopt a cat which is FeLV positive?*YesNoAre you willing and able to adopt a cat which may be prone to urinary crystals/blockages?*YesNoAre you willing and able to adopt a cat which requires long-term medical management for asthma?*YesNoAre you willing and able to adopt a deaf pet?*YesNoAre you willing and able to adopt a FIV postive cat?*YesNoAre you willing and able to adopt a pet which may require future eye surgery?*YesNoAre you willing and able to adopt a pet which may require long-term medical management?*YesNoAre you willing and able to adopt an animal which will require long-term medical management?*YesNoAre you willing and able to adopt a pet which may require medical follow-up?*YesNoAre you willing and able to adopt a pet which will require medical follow-up?*YesNoAre you willing and able to adopt a pet which may require ongoing cardiac assessment?*YesNoAre you willing and able to adopt a pet which may require surgical intervention?*YesNoAre you willing and able to adopt a pet which will require long-term medical management?*YesNoAre you willing and able to adopt a ringworm positive cat and continue treatment in your home?*YesNoAre you willing and able to adopt a ringworm positive dog and continue treatment in your home?*YesNoAre you willing and able to adopt a ringworm positive guinea pig and continue treatment in your home?*YesNoAre you willing and able to adopt an animal that is heartworm positive?*YesNoAre you willing and able to adopt an animal that may require future orthopedic surgical intervention?*YesNoAre you willing and able to adopt an animal which may require long-term management for arthritis?*YesNoAre you willing and able to continue the treatment for demodedectic mange?*YesNoThis is not a contagious disease to other animals or humans.Are you willing and able to continue treatemnt for sarcoptic mange, which is contagious to humans and other animals?*YesNoAre you willing and able to provide a dental cleaning with potential for extractions?*YesNoAre you willing and able to provide dermatological care for this pet?*YesNoAre you willing and able to provide insulin injections to a diabetic cat?*YesNoAre you willing and able to provide insulin injections to a diabetic dog?*YesNoAre you willing and able to provide physical rehabilitiation to this animal?*YesNoAre you willing to adopt an animal that has proven to be high energy?*YesNoAre you willing to adopt an animal that has been known to exhibit resource guarding behavior either toward humans and/or other animals?*YesNoAre you willing to adopt an animal that has been known to be shy and/or nervous?*YesNoAre you willing to adopt an animal that has a history of escaping the home/property?*YesNoAre you willing to adopt an animal with a known bite history to a human?*YesNoAre you willing to adopt an animal with known housetraining struggles?*YesNoDo you have a secure, fully-fenced yard?*YesNoDo you currently have a cat(s) living in the home?*YesNoDo you have a resident cat(s) already in the home or are you interested in adopting two cats together?*YesNoDo you currently have a dog(s) living in the home?*YesNoDo you currently have a dog(s) living in the home?*YesNoDoes your new dog have to be good with other animals?*YesNoHave you read the What to Expect handout?*YesNoDo you live in an adult only home?*YesNoHave you been the sole caretaker for a dog as an adult?*YesNoHave you been the sole caretaker for a cat as an adult?*YesNoDo you live in an apartment or condo-type home?*YesNo Thank you for your interest in this pet. Due to your response, you and this pet are not a match and your questionnaire will not be submitted. Please feel free to go to back to the pet’s profile to learn more via the links in their profile. You can then resubmit if you feel you can provide for that pet’s specific needs. Please visit our Available Pets page to look at other pets for adoption. What is your name?* First Last Email address* Please be sure to add [email protected] to your address book so you don’t miss any important communications from us.Sign Up I would like to sign up to receive emails from Oregon Humane Society about animal rescues, uplifting stories, upcoming events, and more! OHS does not share or sell personal information. What is your mobile or home phone number?*If you provide a mobile number, we will send you a text notification if you are first in line for a pet.Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County Multnomah, Washington, Clackamas, Clark, etc. Ages of any children (under 18) that would have regular contact with this pet?* Please write N/A, if none.Please check any other pets you have in your home currently or that would have regular contact with this pet. Please check N/A, if none.* spayed/neutered canine unspayed/unneutered canine spayed/neutered feline unspayed/unneutered feline small animal/pocket pets other N/A Please specify the age and breed of your pet(s).* Please write N/A, if none.Is there anything else you'd like information on when you arrive? If you require language interpretation services, please select your preferred language below. Arabic Cantonese French German Italian Japanese Korean Mandarin Persian Portuguese Russian Spanish Vietnamese PhoneThis field is for validation purposes and should be left unchanged.