Name* First Last Email* Phone*Why do you want a puppy?*Companion for Another PetCompanion for SelfProtectionGiftSurprise GiftWatchdogReplacement PetTo BreedTo SellTo HuntHow many people live in the household?*The number of people by age/category who live in the householdAdults (19 to 65)Seniors (Over 65)Adolescents (12 to 18)Children (3 to 12)Infants (Under 3) Is anyone in the household expecting a baby?*YesNoExpected due date?How would you rate your general knowledge of puppies?*Very knowledgeableSomewhat knowledgeableLittle to no knowledgeWhat have you have done to prepare for your puppy so far?*Are there any other pets in the household now?*YesNoPlease provide the other pet information:Type of Pet (dog, cat, other)Sex (M, F)AgeSpayed/NueteredWhere Pet Stays (inside, outside, both) Complete a line for each pet.Have you owned any pets before?YesNoIf any pets died in the last 12 months, what where the circumstances?* Old Age Accident Illness Disease Disease Disease Name and address of veterinary clinic you plan to use for your new puppy.*Where will the new puppy spend most of his/her time?*InsideOutsideInside & OutsideDon't KnowAt Work With MeDoggie DaycareWhere will the new puppy stay when no one is home?*InsideOutsideDon't KnowDescribe the pet's outside environment.*Type of shelter, fenced yard, etc.On average, how many hours a day will the puppy be left alone?*0-3 hours4-8 hoursOver 8 hoursWhat age group will have primary responsibility for housebreaking the puppy?*Adult (19 and older)Adolescent (12 to 18)Child (Under 12)Not ApplicableYour type of residence.*Single FamilyDuplexApartmentCondominiumTownhouseMobile HomeRooming HouseDormitoryHow will you train your puppy?*Puppy group classPrivate lessonsWe are not training the puppyI don't know yetWhat will you do with the puppy when you go on vacation?*Take it with usIt will stay with a family memberBoarding at a facilityPet sitterPrivate luxury boarding
