Questionnaire for Prospective Puppy Owners
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
I am interested in a
Please Select
male
female
Color Preference
Please Select
liver
liver roan
liver & white
i want my puppy for (select all that apply)
pet
show
hunting
obedience
agility
dock diving
Do you plan to acquire titles in any are area (select all that apply)
Conformation
hunt test
field trials
obedience
dock diving
agility
Family
Name of Spouse/ Companion
Number of Children and Ages
Will anybody else be living with this puppy?
Pet Ownership
Have you previously owned this breed?
Please Select
yes
no
If not, what attracted you to this breed?
What kind of research have you done on this breed?
Do you have any other pets?
Please Select
yes
no
If yes, please list
Do you currently breed dogs or have in the past?
Please Select
yes
no
if yes,how many litters do you breed per year?
Are you interested in breeding this puppy
Please Select
yes
no
which of the following reasons best fits why you want this puppy? ( select all that apply)
pet
personal hunting dog
field trial/ hunt test/ NAVHDA
dock diving
conformation
therapy/service work
obedience/rally/agility
other
Training
Do you believe in crate training your puppy?
Please Select
yes
no
Do you believe in obedience training your puppy?
Please Select
yes
no
Do you plan to do hunt training ?
Please Select
yes
no
Will you be attending puppy classes with your puppy?
Please Select
yes
no
Type of Home
Do you own your home?
Please Select
yes
no
If not, does your landlord allow large dogs?
Please Select
yes
no
landlords contact information for approval
Facilities and Care
we prefer our dogs be in homes where they are allowed in the house. These are social, companion animals that need interaction with their families.
On average how many hours will your puppy be left alone?
Where will the puppy be kept when you are home?
Where will the puppy be kept when you are not home?
Description of outdoor area for puppy
Please Select
fenced yard
unfenced yard
invisible fence
Size of yard?
Size of kennel/ exercise area?
How much exercise will your puppy get a day?
What type of exercise will you provide?
walk
hike
swim
treadmill
other
Additional Information
What arrangements will be made if your puppy is not able to travel with you?
Is anyone in your family allergic to dogs or dog hair?
Please Select
yes
no
Are you willing to purchase a puppy on limited registration ( no breeding)
Please Select
yes
no
Do you agree to return puppy to breeder or ask for assistance rehoming puppy if you are no longer able to care or keep puppy for any reason?
Please Select
yes
no
Do you agree to keep breeder current with regards to your address, and inform breeder of any problems that arise with puppy during his/her lifetime?
Please Select
yes
no
Do you have a veterinarian, or have contacted one for when your puppy arrives?
Please Select
yes
no
Veterinarian contact information ( please contact your veterinarian and authorize me to speak to them about past and current pets)
Do you agree to obtain all vaccines and preventative care?
Please Select
yes
no
Do you agree to keep your puppy on heartworm and flea/tick preventative for the life of your puppy?
Please Select
yes
no
Are you willing and financially able to afford long term or expensive treatment if the situation arises with your puppy?
Please Select
yes
no
Submit
Should be Empty: