name:________________________________

phone:_______________________________

city & state:________________________________

how did you hear about us?_______________________________________

what breed are you interested in?_________________________________

size:______________________________

color:___________________________

sex:_______________________________

ideal time frame for bringing your puppy home:  __________________________________

are you interested in pet/companion or therapy/services?________________________________

have you ever owned a dog before?________________________

do you or anyone in your home suffer from allergies?______________________________

if so, mild, moderate or severe?_______________________

do you understand we require spay/neuter?_______________________________

tell us about you/family: ____________________________________________________________________

_______________________________________________________________________________________________

is there any additional information you would like to share with us that may help us better assist you in the search for your new puppy________________________________________

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