Cloverleaf Animal Clinic

749 N. White Station
Memphis, TN 38122


Adoption Application Form

Name of pet(s) applying for (required)

Name (required)
First Name (required)
Last Name (required)
Address (required)
Street Address (required)
City (required)
State / Province (required)
Zip / Postal Code (required)
Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Why do you want to adopt a pet? (required)

What do you think are the most important responsibilities in owning a pet? (required)

Please list any preferences (age, sex, breed, personality) (required)

Are you willing to take time to housebreak a pet, and do you understand that changing a pet's environment may cause the pet to have accidents? (required)
If you are applying for a pet who needs to be house-trained, how will you house-train the pet? (required)

If a behavioral problem arises, what steps will you take to work on it? (required)

Does any member of the family have allergies to animals? If yes, explain. (required)

Describe the kinds of personal situations where you might have to return your adopted pet. (i.e. job loss, children, move, marital change, etc.) (required)

How many people live in your home? (required)

Are there any children in the household? If yes, what are their ages? (required)

Who will be responsible for feeding and taking the pet outside/cleaning litter-box?

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Cloverleaf Animal Clinic
749 North White Station Road
Memphis, TN 38122









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