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Questionnaire

Name *

Phone *

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Country

Occupation *

Do you have any children? *YesNo

What are their ages? *

Does everyone in the family agree on getting a dog? *YesNo

Does anyone in your household have allergies to animals? *YesNo

How severe are the allergies? *

Who will be the primary care giver of the puppy? *

Have you ever owned a dog before? *YesNo

What breed(s)? *

How long did your last dog live? *

What were the circumstances of it's death? *

Do you currently have any other pets/animals? *YesNo

What pets do you own? Please specify *

Do you already have a trusted veterinarian? *YesNo

Name of Vet *

Address of vet clinic *

Phone number of your vet *

If there would be changes in your family’s situation such as a change in occupation or residence, or having a new baby, what will happen to the dog? *

Have you ever returned a pet to the breeder? *YesNo

What were the circumstances of the return? *

Have you ever given a pet away? *YesNo

What were the circumstances of the give away? *

Have you ever taken a pet to a pound or shelter? *YesNo

What was the reason you took the pet to a pound or shelter? *

Type of dwelling *HouseCondoApartmentMobile home

How long have you lived in your current residence? *

Are you renting? *YesNo

Are you allowed to have a dog or pets? *YesNo

Landlord name *

Landlord phone *

What kind of floor surfaces will the dog be on in the house? *

Do you have a yard? *YesNo

Is it fenced? *YesNo

How high is the fence? *

How will the dog exercise? *

Will you be willing to build a secure space or suitable pen for the dog so it can burn off energy without being supervised? *YesNo

Will the dog receive crate training? *YesNo

Why do you want this specific breed? *

What reference materials have you read about this breed? *

How many individuals of this breed are you acquainted with? *

How did you bear about this breed? *

What activity level do you expect from this breed? *Very HighHighModerateBelow Average

Are you aware of the health issues that may affect this breed? *YesNo

What gender are you most interested in? *FemaleMale

What age do you wish to get the puppy? *

Have you considered an older dog instead of a puppy? *YesNo

What are the important factors of a dog for you? Rank the following with 1 being the highest priority:

Conformation (looks) *

Breeding potential *

Fieldwork or hunting ability *

Temperament *

Gender *

Pet Therapy *

Search and rescue *

Family Companion *

Show dog quality *

Ability to compete in obedience or agility *

Other important factors:

Where will the dog live? Inside, outside, or both? *InsideOutsideBoth

Where will the puppy be kept during the day? *

Where will the puppy be kept during the night? *

How many hours a day will the puppy be kept outside? *

How will the puppy be confined when outside? *

Is anyone going to be at home throughout the day? *YesNo

How many hours will the dog be left alone during an average day? *

Will there be someone available to feed and exercise the puppy during the day? *YesNo

Are you interested in showing the dog in the conformation ring? *YesNo

Have you ever shown a dog to its championship? *YesNo

Do you have dogs that completed AKC titles? *YesNo

Please specify: *

Have you had experience breeding dogs? *YesNo

Do you intend to breed this dog? *YesNo

Have you ever house-trained a dog before? *YesNo

Will you be attending any training classes with the puppy? *YesNo

What age will you start training? *

Do you plan on having the dog spayed or neutered? *YesNo

Are you interested in competition in performance events such as obedience, agility, hunting, herding, etc.? *YesNo

Which activities or competitions are you interested in? *

Who will be the trainer? *

If you’re planning to have this puppy join dog shows or performance events, please provide references (breeders, trainers, etc.). *

Have you shown a dog to any performance titles? *YesNo

Please specify: *

Do you understand the difference between a limited registration and full registration? *YesNo

Do you have any questions or other information you want to share? Feel free to let us know!

Thanks!

Thank you for your time in answering our questions candidly. Your answers won’t be the only factor in determining whether any of our puppies should go home with you. We’ll reach out to you about how we’ll move on with the process of your search for a dog as an addition to your family.

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  Louisa, Virginia
  434-906-3607
  Shannon@
virginiapoodlesanddoodles.com

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