Exotic Pet Adoption Survey

Name

Email Address

Street Address

City

State

Zip

Primary Phone

Secondary Phone

Please list the human members of your household. If there are children, what are their ages?

Please list the animal members of your household (species and breed).

Do you rent or own your home? Do you rent or own your home? Rent Own

Have you ever had an exotic pet before? Have you ever had an exotic pet before? Yes No

Are you interested in a specific pet?

Where in your home do you plan to house your exotic pet?

How do you plan to house your exotic pet?

What do you plan to feed your exotic pet?

Do you currently have a vet? Do you currently have a vet? Yes No

Please list your vet's name

Are you willing/able to bring your adopted pet to a specialized exotic veterinarian for care? Are you willing/able to bring your adopted pet to a specialized exotic veterinarian for care? Yes No