Todays Date
Name
Email
Address
City
State
Zip
Phone Number
How did you find us
Surfed web linked from another site referred by someone Other
What is your primary reason for wanting to purchase a puppy from us? I'd like a companion I want a family dog I want a dog who will herd my stock My other dog needs a friend I want to show the dog at dog shows I want to play (agility, flyball, herding, etc.) I'd like to become a breeder Other reason (please state)
What else do you want to do with your puppy? Check all that apply: Obedience 4H Agility Therapy visits Herding Tracking Other (be specific):
Do you currently have pets in the household? If yes, what type and what ages? Yes No
Is this your first puppy or dog? Yes No
Do you have children living in the household? How many and what ages? Yes No
Do you have a fenced yard? If yes, describe briefly Yes No
Do you have a veterinarian? Yes No
List any books on raising puppies or training dogs that you have read recently
How much time will your puppy be alone during the day? What will you do with the puppy when you are gone?
How do you plan on exercising your dog?
What type of training will you do with your dog? Be specific.
Where will your dog sleep?
What will you feed your dog?
Will you have your dog spayed or neutered? Yes No
Have you met any Mini Amerrie/Mini Aussies in person? If yes, what did you think of them? Yes No
Why are you attracted to this breed?
Please comment on how you envision living with your new puppy.
Do you prefer or require a certain sex? prefer male prefer female require male require female sex doesn't matter
Do you prefer or require a certain color? prefer blue/black prefer red require blue/black require red color doesn't matter
Do you prefer or require a certain color pattern? prefer merle prefer tri require merle require tri color pattern doesn't matter
What is the most important factor you want me to use when deciding on a puppy for you? (Choose from the dropdown box) Temperament Potential as a Show/Breeding Prospect Color/pattern Potential as Obedience/Agility Competitor Sex
Second most important: Temperament Potential as a Show/Breeding Prospect Color/pattern Potential as Obedience/Agility Competitor Sex
Third: Temperament Potential as a Show/Breeding Prospect Color/pattern Potential as Obedience/Agility Competitor Sex
Fourth: Temperament Potential as a Show/Breeding Prospect Color/pattern Potential as Obedience/Agility Competitor Sex
Fifth: Temperament Potential as a Show/Breeding Prospect Color/pattern Potential as Obedience/Agility Competitor Sex
What concerns do you have about this breed?
What questions do you have for me?
PLEASE REVIEW YOUR ANSWERS CAREFULLY. WHEN YOU ARE SATISFIED, CHECK THE BOX BELOW I've reviewed my answers
Thank you so much for taking the time to complete this questionnaire. While it does not take the place of a personal conversation, this will help me when I contact you about a potential puppy placement. You should expect to hear from me within a few days of receiving your message. Thank you choosing us!
Sharon Birchview Kennel
One more step: to forward your answers to me, press the SEND button. If you want the form wiped clean, press the CLEAR button.
