Name     E-mail
Briefly describe the immediate family structure such as yourself and your spouse, number of children and/or grandchildren, their genders and ages etc. If Grandma and Grandpa and/or a brother, cousin, employee (nanny, cleaning crew etc.), frequent the house on a daily or regular basis they may be considered immediate, and should be included.
TYPE IN RESPONSE
 
Describe the living environment – Private home, townhouse, condo, apartment, back seat of your car, etc., and the immediate area surrounding your residence (any fenced areas, pool, flower beds, etc)
TYPE IN RESPONSE
 
What is the main purpose for acquiring the dog and what role do you envision this dog playing in your life?
TYPE IN RESPONSE
 
 
Have you ever had a dog before?
YES
Have you in the past, or do you currently, own any other animals?
YES
Number of residence for dog to acclimate
Describe the activity level at your residence(s).
LOW    MEDIUM    HIGH    VERY HIGH
Do other dogs frequently vsit your home?
YES
How do you travel with your dog?
BY CAR    PLANE    BOAT    OTHER
Please note that this should be considered a “generic” and “rough” draft of information that I deem necessary in acquiring the right dog for you and your situation. If there is any additional information that you wish to add, please do so. Be specific as to your wants and needs. Please fax or e-mail your response to me personally. I thank you in advance and will be in touch soon.

TYPE IN RESPONSE