Questionnaire

Questionnaire for getting just the right puppy.

Copy and paste or print and fill out and send via email or usps.

PUPPY OF INTEREST: _______________________________________________________________________ PERSONAL INFORMATION Name:___________________________________________ Age:!Under 20 •!20-35 •!35-50 •!50+ Name of !spouse •!partner

•!roommate:____________________________________________________

Street address: ________________________________________________________________________City: _____________________________________________________ State: _______ Zip: _____________ Home phone: _____________________________

Work phone: ___________________________________
Cellular phone: ____________________________
email: _________________________________________
Occupation: __________________________________
Spouse’s occupation: __________________________
Work schedule:________________________________
Spouse’s hours: ______________________________
Names of all persons living in your household, their relationship to you and their ages: __________________________________________ __________________________________________ __________________________________________ __________________________________________

Please list two personal references and their relationship to you: Name:___________________________ Relationship:________________
Phone: ____________________

Name:___________________________ Relationship:________________
Phone: ____________________

YOUR HOME Type of dwelling? ! House • ! Apt • ! Condo • ! Other ___________________________________________
Own or!Rent?
If Condo, what are the association’s rules about pets? _____________________________
Your home has: ! 1 story • ! 2 stories
If you have yard: ! Fenced (height: _____ feet) • !
Unfenced
Does your home have a pool? ! Yes • ! No If you have a pool, is it fenced?______________________________________________________________
How do you introduce a dog to pool? ___________________________________________________________
Do you have the landlord’s permission to have a dog? ____________
Landlord’s name: _____________________________________
Phone: ______________________________

Do you presently have a dog? Yes •No
Have you previously had a dog? Yes •No
If you presently have or had dogs in the past, please complete the charts below.
In the column, “what happened,” write: gave away, sold him/her, took to the pound, abandoned, died, etc. (If the dog died, please state cause of death.)

CURRENT DOG(S) Name & Breed Age Sex Altered?
PREVIOUS DOG(S) Breed Age Sex Altered?
Kept In/Out Have any of your dogs ever had puppies?  Yes •  No
If Yes, you breed for:  Fun •  Profit •  Show •  Accident
How & Why Obtained?
What Happened?
How Long?
What Year?
Has any member of your family ever experienced animal-related allergies?  Yes •  No
Have you ever trained a dog in obedience classes?  Yes •  No
Have you ever trained a dog?:  Basic Commands •  Herd •  Hunt •  Guard/Attack •  Other _______________
If you have other pets, please complete the following chart:
Species
How many?
Ages
Kept where?
Since what year?
If cat, declawed? If yes why?
Your Family Veterinarian: Name:_______________________________________ Phone: _____________________________________
YOUR NEW PUPPY Who would be responsible for the care of the dog?__________________________________________________

What is your primary reason for getting a new puppy?  Companion •  Guard dog •  Fighting •  Hunting •  Attack dog •  Other
If Companion, whose?  You •  Spouse •  Children •  Other pet •  Someone else (who?): _______________
Where would the dog sleep?  Inside (where? ________________) •
 Outside (where? ________________)
How many hours per day would the dog be left alone? _______________________________________________
Where would the dog be left when he/she is alone?  Indoors •  Outdoors
If outdoors:  Yard •  Patio •  Kennel •  Garage •  Other
If yard: Do you have a doggie door?  Yes •  No
Do you intend to hire a dog-sitter or take the dog to the daycare center?  Yes •  No
When you are at home, the dog would be:  indoors •  outdoors •  other (where?) ______________________
Which rooms or areas of the home/yard will be off-limits to the dog?: ____________________________________
Do you allow dogs on furniture?  Yes •  No •  Some (which?) _____________________________________
 If the dog will be outside at all, what outside space is available for the dog:  Yard •  Patio •  Run •  Balcony •  Unfenced yard •  Other: ___________________________________
Are the gates:Latched •Padlocked •Other (explain): _________________________________________
How do you plan to handle dog’s exercise needs? ___________________________________________________ _______________________________________________________________________________________
Do you feel obedience training makes a dog a better companion?  Yes •  No If necessary, would you be willing to attend obedience classes at your own expense?  Yes •  No
Do you travel a great deal? Yes •No
How often?______________________________
How long at a time?_____________________________
When you do travel, how do you intend to provide for the dog while you are gone?__________________________ _______________________________________________________________________________________
What provisions would be made for the dog if you had to move to: Locally? ________________________________ Out of state?__________________________________
To a place where no pets are allowed?________________________________________________________
Under what circumstances would you not keep the dog? Divorce •Illness in family •Moving •New baby •New job •Housetraining problem •  Chewing •  Barking •  Digging •  Allergy •  Shedding too much •  Dog grew too big • Dog became ill •Kids ignore the dog •Pets didn’t get along •Not obedient enough • Other (explain)_______________________________________ •
Would not give up for any of the above What would you do if the dog grew to be bigger than you expected?
Return the dog to rescue •
Take the dog to shelter •
Keep the dog but keep him outside 
Other (explain)______________________________________________________________ •Nothing
If the dog becomes destructive at your home, what would you do? ______________________________________ _______________________________________________________________________________________
If the dog has “accidents” at your home, what would you do? __________________________________________ _______________________________________________________________________________________
If the dog shows Separation Anxiety, what would you do? _____________________________________________ _______________________________________________________________________________________
If the dog becomes aggressive to people and/or dogs, what would you do? • People Aggression: ________________________________________________________________________ • Dog Aggression: ________________________________________________________________________ Is there anything else you would like to tell us about yourself? _____________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Questionnaire Information: All of the information I have provided in this Questionnaire is true and correct. If any of the information changes, I will advise you promptly.
Signature: __________________________________________________
Date: ________________________
Print Name: ________________________________________________