Consultation Questionnaire

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you need this puppy shipped? *

Yes

No

Why do you want to adopt this/a pet? *

To Sell

To Breed

Companion for self

Companion for another pet

Watchdog

Replacement Pet

Protection

Gift

Surprise Gift

Other

The number of people by age category who live in the household? *

Check all that apply

Adults 19 to 65

Seniors Over 65

Adolescents 12 to 18

Children 3 to 12

Infants Under 3yrs

How would you rate your general knowledge of the type pet you are interested in adopting? *

Very Knowledgeable

Somewhat Knowledgeable

Little or No Knowledge

How long have you actively been looking for a new pet? *

Days

Weeks

Months

Doesn't apply to me

Are there other pets in the household now? *

Yes

No

If there are no pets in the household now, have you owned any pets before? *

Yes

No

If you owned pet(s) before where is he/she/they now? Explanation: *

Don't Know

Gave Away

Lost, never found

Died

Sold

Never owned a pet before

Where will the new pet spend most of his/her time? *

Inside

Outside

Inside & Outside

Don't Know

Where will the new pet stay when no one is home? *

Inside

Outside

Don't Know

How many persons will be responsible for housebreaking or training the pet? *

1 Person

2 People

3 People

4 or more people

Which is your residential area described as? *

Urban (city)

Suburban (Outlying area of the city)

Rural (country)

Don't Know

Type of Residence *

Single Family

Duplex

Apartment

Condominium

Townhouse

Mobile Home

Rooming House

Dormitory