COVID-19 Home Visit Questionnaire

This form is for the adopter to fill out in the event that a physical home check is required. All answers must be truthful and honest. You may be asked to complete the form, and your answers will be reviewed by the adoption team. If you are self-isolating or have any concerns surrounding Covid-19, please inform a team member and we will be happy to discuss matters further.

If the answer is “yes” to any of the questions, we will postpone the visit.
I confirm the above information is accurate.

Current details on COVID-19 can be found on the World Health Organisation web site or from the Centers for Disease Control and Prevention web site.