EmailMe Form - Puppy Questionairre

Name

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone

### - ### - ####

YOUR VETERINARIAN NAME

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

What is your occupation? *

ARE YOU INTERESTED IN *

What breed are you interested in

Golden

Havanese

What other pets do you have? *

Do you plan to acquire any more dogs in the next year? *

Have you ever had to release a dog to rescue or back to the breeder?

What pets have you had in the past and where are they now?

How many children do you have? *

Who lives in the house? Parents, kids, grandparents, etc? *

Do you or anyone in your family have any health issues or handicaps? *

Does anyone in your house smokes?

Where do you live? *

Is your yard fenced? *

Do you know how to house train a puppy?

Preference on Male or Female *

Are you willing to sign a spay/neuter contract?

How will your puppy get exercise? *

How many hours per day will your puppy be alone? *

Where will he sleep at night?

What food, treats and toys do you plan to give him?

What flea/tick preventative do you plan to use?

What heartworm preventative do you plan to use?

Who in your family will be the primary caregiver? *

When you are on vacation, who will care for your puppy? *

Do you have any questions for me?

Please provide any other information about yourself or your family you’d like to share.