Date Phone (land)Phone (cell)Your Name*EmailYour Schedule*List family members/age of kidsYour leisure activitiesWill you include the dog in these activities?YesNoDo you have other pets?YesNoWhat kind?AgeDoes your current pet have experience with dogs or puppies? ExplainHave you owned a dog before?YesNoHave others in your family raised a dog?YesNoIs everyone in your family eager to have a dog?YesNoHave you successfully trained a dog?YesNoFurther room to explain your situation:Please indicate the appropriate description:I live in aLarge houseSmall houseApartmentI have a:Large yardSmall yardNo yardPlease enter one of these response to the activities listed below: I have time for a dog that needs ______ grooming.Very littleModerate amounts ofExtensiveI have time for a dog that needs ______ training.Very littleModerate amounts ofExtensiveI have time for a dog that needs ______ attention.Very littleModerate amounts ofExtensiveI have time for a dog that needs ______ exercise.Very littleModerate amounts ofExtensivePlease indicate the appropriate response:I’m getting a dog to be_______.A family memberA watchdogUsed for workType of workI’d like a dog who is_______ of children.Very acceptingTolerant, but aloofDoesn't pertainI’d like a dog who needs_______affection.Very littleModerate amountsA lotI’d like a dog who_______.Is naturally activeEnjoys quiet walksDoesn't need extensive exerciseI’d like a dog who is _______ strangers.Naturally protective aroundAccepting ofAloof towardI’d prefer a dog who sheds _______.Very littleA couple of times per yearShedding doesn’t matterI’d like a dog whose coat is_______.LongShortThickFeatheryCurlyWiryAny of the aboveWhen we go on trips, the dog would be _______.Taken alongKenneledLeft with friends or familyYour CommentsAre you interested in a puppy or older dog or are you open to either possibility? Other ConsiderationsOther ConsiderationsSetting up a session:AMDaytimeEveningIdeal days and other scheduling comments (list 3 options):PaymentPayPalOther type of paymentPhone SessionsHalf Hour $75.00Full Hour $150.00
