• Name: Address: Phone (home): work: 
• Referred by: 
• What reference materials have you read? How many individuals of this breed are you acquainted with?
• Type of dwelling:      house      condo      apartment      mobile home 
• If renting, please give name and address of landlord: 
• Name, address and phone number of your veterinarian:

• Who will be the primary care giver? 

• Where will the puppy be kept during the night?

 
• Where will the puppy be kept during the day? 

• Is anyone home during the day?

 
• How many hours on the average will the puppy be left alone?

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

 
• Have you ever owned a dog before?

• Do you have any other animals?

 
• Do you have any children? If yes, what are their ages. 

• Does anyone in your household have allergies to animals?

 
• If yes, to what and how severe?

 
• Are you interested in a male or female puppy?

 
• At what age do you wish to get the puppy?

 
• Have you considered an older dog instead of a puppy?

 
• How did you bear about this breed? 

• What do you expect the activity level of this breed to be: very high    high     moderate     below average

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

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

 
• How will he be confined when he is outside?

 
• Do you have a fenced yard or suitable pen? 

• Have you ever house trained a dog before?

 
• How long have you lived at this address? 

• Will you be attending any training classes? 

• If yes, at what age will you start, which activities or competitions are you interested in, who is the trainer?

 
• How long did your last pet live? What were the circumstances of its' death?

 
• Have you ever returned a pet to the breeder? If so, what were the circumstances?

 
• Have you ever given a pet away? If so, what were the circumstances?

 
• Have you ever taken a pet to a pound or shelter? If so, what were the circumstances?

 
• Are you interested in showing the dog in the conformation ring?

 
• Have you ever shown a dog to it's championship?

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

 
• Have you shown a dog to any performance titles?

 
• Do you intend to breed the dog?

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

Article reprint from Show Dog Super Site http://www.showdogsupersite.com/kenlclub/k9journal/pupques1.html