Adoption Form - Kittery Animal Hospital

Owner Name*

First Last

Address*

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

Email*

Primary Phone*

Secondary Phone

How did you hear of us?*

Website
Sign
Facebook
Google
Referral
Other

Please specify the animal(s) you are interested in adopting:

Thank you for considering adopting a dog from our shelter. You will be making a 10-15 year commitment and our goal is to help make the best possible match for you and our shelter animals. The following questions will help us achieve that goal.

Do you currently live in a:

House
Apartment
Condo
Other

Do you currently:

Rent
Own

If you rent, may we contact your landlord to verify their pet policy?

Yes
No

Landlord’s Name

Phone

How many adults live in your home?

How many children?

If there are children in your home, what are their ages?

Does anyone in your household have pet allergies?

Yes
No

Who will be primarily responsible for the care of this pet?

Is this pet a gift?

Yes
No

If yes, for whom?

Where will the pet be kept at night?

Pet Information

Pet name*

Species*

Dog
Cat

Breed*

Color markings*

Date of birth or age*

Sex*

Male
Female

Spay or neutered?*

Yes
No

Name of previous vet?*

Would you like us to request medical records from previous caregiver?*

Yes
No

If yes please provide contact information for us:

Add a second pet?*

Yes
No

Pet name*

Species*

Dog
Cat

Breed*

Color markings*

Date of birth or age*

Sex*

Male
Female

Spay or neutered?*

Yes
No

Name of previous vet?*

Would you like us to request medical records from previous caregiver?*

Yes
No

If yes please provide contact information for us:

Add a third pet?*

Yes
No

Pet name*

Species*

Dog
Cat

Breed*

Color markings*

Date of birth or age*

Sex*

Male
Female

Spay or neutered?*

Yes
No

Name of previous vet?*

Would you like us to request medical records from previous caregiver?*

Yes
No

If yes please provide contact information for us:

I grant Kittery Animal Hospital and Creature Comforts permission to post my pet’s picture and story on social media.*

Yes!
No, thank you

We will gladly prepare a written estimate if you desire (please ask your technician or doctor). This will be important to you since ALL SERVICES ARE DUE THE TIME SERVICES ARE RENDERED.

We accept Cash, Check, Visa, MasterCard, Discover or Care Credit Card.

Digital Signature*

By signing this document you agree to accepting all financial responsibility for any and all treatments performed, and that you are at least 18 years of age or older.

Date*

Email