Expression of Interest - Other | Lort Smith Animal Hospital

Please note: completion of this form indicates an expression of interest only and does not guarantee adoption.

*mandatory field

Name*

Phone*

Email

Have you had a pocket pet before?*

Yes
No

What species?*

Do you currently have any pets?*

Yes
No

What animals and how many?*

Are your current pet/s registered with your local council?*

Yes
No

What type of housing to you have?*

Flat/Apartment
Unit
House
Farm

Do you live in a rental property?*

Yes
No

Have you received landlord approval for a pet?*

Yes
No

What are your normal working hours?*

Will the pet be an indoor or outdoor pet?*

Indoor
Outdoor
Both

Where will the pet sleep?*

Where will the pet be kept when you are out?*

Who else lives in the house or will have regular contact with the pet?*

Children
Other adults
Elderly
Disabled
Impaired
N/A

What age/s?*

Do you travel regularly for work or holidays?*

Yes
No

Who will look after the pet while you are away?*

Are you fully aware of all the responsibilities and financial requirements regarding ownership of a pet?*

Yes
No

Is there anything that you are aware of that would mean you will not be able to care for the animal for the rest of its life? E.g. moving/working overseas in the future*

Yes
No

What arrangements would you put in place should that occur?*

How did you hear about this animal?*

How?*

Is there anything else you would like to tell us about you, your household or lifestyle?

Expression of Interest – Other