Home Ever After – Other Animals Assessment Form This form is to be used for all animals except Dogs, Cats, Horses and Pocket Pets. Please complete all relevant sections. For multiple animals, please list any particulars pertaining to each animal/bird. 1Personal Information2Vet Details3Animal Information4Environment/Lifestyle5Play/Exercise6Family Relationships7Handling8Aggression9Can we? This form is to be used for all animals except Dogs, Cats, Horses and Pocket Pets. Please complete all relevant sections. For multiple animals, please list any particulars pertaining to each animal/bird.Personal InformationName* First Last Address* Address line 1 Address line 2 Town/suburb State Postcode Email* Phone: HomePhone: Mobile*Preferred method of contact Mobile Home Best time to contact Morning Afternoon Evening Second owner's details if any First Last Email PhoneYour HEA Agreement form must be witnessed, please provide their details:* First Last Email* Address* Address line 1 Address line 2 Town/suburb State Postcode Vet DetailsClinic* Name Vet First Last Address* Address line 1 Address line 2 Town/suburb State Postcode AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Phone Animal InformationName First Date of birth MM slash DD slash YYYY Species/ Breed Weight Sex Desexed? Yes No If yes, when? Microchip Number or Tag ID no (if applicable) Colour Distinguishing Features Medications? Please SpecifyVaccinations Due/WhenRegistered with council? Yes No Where did you obtain this animal? Breeder (if applicable) Environment/LifestyleFor what purpose did you get your animal? Companion Show Breeding Age Obtained FeedingType of food Amount Fed Frequency of feeding When fed and where? Who does the feeding? (describe eating) Favourite treat Supplements given Play/ExerciseFavourite game Type of exercise Amount/Frequency of exercise Amount/Frequency of play Favourite Toy(s) Do you take your animals on walks/ details? Describe where your animal stays at each of the following times:Daytime (owner away) Daytime (owner home) Night time When guests visit? How long is your animal alone each day? How long is your animal alone each day? Reaction prior to departure Reaction to homecoming Left alone outdoors? How often/long? Where is your animal when outside? Type of dwelling How does your animal react to car rides? Family RelationshipsList family members (include sex and age) who have a relationship with the animalList all other pets including breed, age and sex:Describe how your pets get along with each member of the family and each pet:Briefly describe your animal's personality: HandlingHow does your animal react to the following? Nail Trimming Cleaning Ears Giving Medication Grooming/Bathing Petting Rubbing Belly Strangers visiting home Being lifted Rolling over New animals entering home Strangers arriving indoors AggressionIs your animal aggressive toward family members? Yes No If yes, how Is your animal aggressive toward other people? Yes No If yes, how Has your animal ever bitten hard enough to break the skin or cause injury? Yes No If yes, under what circumstances did this occur? How long ago? Was there an illness or health problem when the aggression started? When your animal is aggressive what is your response? Anything else you would like to share?Phobias/ sweet characteristicsAdditional Comments Can we….Re-home with children? Re-home with male/female? Re-home with a dog? Re-home with a cat? Needs a quiet home? Please attach a photo of your animalMax. file size: 64 MB.Consent* By clicking on the submit button, you declare that you are the legal guardian of the pet and the information you have provided is accurate and true as of today’s date.
