Full Name:

Street address:

City, state & zip code:

Do you own or rent your home?

Own-Buying Other Rent

Yes No

Large Medium Small None

Rural Suburban

Yes N/A No 

Yes No

You bet! No Thanks

Yes No

Yes No Unsure

Yes No

Do you have a securely fenced yard (no gaps)?

Yard Size?

Residence?

Type of home (i.e. apartment, two story, mobile etc.)?

Where will your pet spend most of its’ time?

How long have you lived at your current location?

Do all parties involved (especially landlord & neighbors) approve of this adoption?

How many dogs have you owned?

Why did you choose this puppy and breed ? (enter “waiting list” if unborn)

Have you ever housetrained a puppy?

How do you plan to train your puppy?

Would you like to receive a free training and care guide?

What types of behavior will not be tolerated from your new puppy?

What size (pounds etc.) do you hope your puppy to be when mature?

Please list all animals currently living in your house.

Are your pets spayed or neutered?

What is the shortest span of time you have owned a pet?

Please list the number of, and ages of children living or frequenting your home.

Are you willing to provide daily care for your pet for the next 10 plus years?

How did you find GoMODOG.com (i.e. Referral, Google, PuppyFind, Magazine, etc.)?

List name(s) and phone number(s) of your landlord and or a nearby friend.

Provide your phone number, e-mail address and a good time for us to call.

Are you a breeder, dealer, broker or pet store owner?