Puppy Questionnaire

Name: *

First

Last

House Number and Street: *

City: *

State *

Zip Code: *

Phone number (cell) *

Phone number (home)

Email *

How many adults do you have in your house? Please include yourself. *

What are their ages? *

How many children do you have in your house? *

Please list their ages: *

What are the occupations of the adults in your house? *

Who will be the dogs primary caregiver? *

On average, how many hours per day will the dog be alone? *

1-3
4-6
7-9
10 or more

Will there be someone who can exercise the dog during the day? Please give details: *

Have you ever had a dog before?

Yes
No

If yes: is the dog still alive? Please give age. It not, what happened?

Have you ever had a dalmatian before? *

Yes
No

If yes, please give details:

What type of training do you plan for your puppy? *

Where will the puppy sleep for the first few months in your home? *

Where will the puppy sleep once they are house trained to not have accidents or be destructive? *

Does anyone in your household smoke or use vape products? *

Yes
No

If yes please give details:

Do you own your home or rent? If rent, are you permitted to have a pet dog? *

IF RENTED HOME: please provide Landlord name and contract information:

Do you have a fenced in yard? *

Partially fenced
Fully fenced
Already have an invisible fence
Willing to put in an invisible fence

If none of the above, how will the dog be contained when outside?

Approximately how big is the outside area your dog will have access to? *

Please check all that apply: *

Do you have any other animals? Please give details: *

Are your current pets up to date on vaccinations? *

Yes
No
No other pets/not applicable

Why are you interested in a dalmatian? *

Have you ever returned a pet to a breeder? *

Yes
No

If yes, please explain:

Have you ever given a pet away? *

Yes
No

If yes, please explain:

Have you ever surrendered a pet to a shelter or rescue organization? *

Yes
No

If yes, please give details:

What does your average weekday look like? *

What does your average weekend look like? *

Puppies are not easy – they pee, poop and like to make messes! Are you 100% sure that you have the time, patience and commitment to dedicate to a puppy? *

Yes
No

Would you be able to provide references from a veterinarian as well as a personal reference if required? *

Yes
No
Unsure

Would you be comfortable with an in-home screening? *

Yes
No
Unsure

What type of puppy personality do you feel would match your family best? *

If there is anything else you would like us to know, please use the box below:

Where did you hear about Symphony Dalmatians? *

I have read the article below 'Is a Dalmatian Right for You' from the Dalmatian Club of America. *

Yes

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