Questionnaire

Contact Information

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Facebook Username *

Instagram Username *

How many adults live in your home? *

Who will be the primary care giver? *

Do all members of the family want a new puppy? If no, please explain. *

If your family circumstances change (ex: new baby, change of residence or job) what will happen to your dog? *

If the need to rehome this dog arises, do you agree to return the dog to me? *

How many children live in your home? What are their ages? *

Is the puppy going to be a surprise for anyone? *

Please provide breeds, ages, and genders of any currently owned pets or previous owned pets. *

Have you ever given a dog away, rehomed a dog, or taken one to the shelter? If yes, please explain. Comment *

What is your occupation? *

Do you have a veterinarian? Please provide name or office. *

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