Puppy Questionnaire

Thank you for your interest in a Breugel's Bouvier des Flandres Puppy.   I use my puppy questionnaire to ensure that all my puppies go to the best homes possible, be it a pet or a show home.   Please help me by filling in this confidential questionnaire that will only be used for the purposes of placing a puppy into its new home.   This questionnaire may seem involved but as a potential owner you should be pleased that I place my puppies very carefully.

A Bouvier des Flandres has an average life expectancy of 10 to 12 years and you will be responsible for the care and well being of your loyal companion from puppyhood to old age and as such your decision should not be taken lightly.   Please educate yourself on the breed before making your decision.

Contact Information

Name: *

Please enter your first and last name.

Email: *

Please enter your email address. We can not respond unless it is entered.

Address:

Please provide your street address.

City:

Please enter the city or town where you live.

Prov/State:

Please enter the province or state that you live in.

Phone:

Please enter your 10 digit phone number.

Best time to contact you?

MorningNoonAfternoonEveningOther (please specify)

Please specify:

Referral

How did you find us?

Alberta Bouvier ClubDogs in Canada MagazineInternet/Search EngineOther (please specify)Referral (referred by)

Referred by:

Please specify:

Puppy/Dog

Are you interested in?

PuppyAdult dogMore specific (please explain)

Please specify:

What gender do you prefer?

MaleFemaleNo Preference

What coat color do you prefer?

BlackBrindleFawnGreyGrey BrindleSalt & PepperNo Preference

Do you prefer natural or cropped ears?

CroppedNaturalNo Preference

What are your plans for your Bouvier?

CompanionBreedingShowingWorking

What activities are you interested in pursuing?

AgilityCartingConformation HerdingKNPVPersonal ProtectionObediencePet TherapySchutzhundRing SportOther (please specify)

Please specify:

Why are you interested in a Breugel's Bouvier?

Have you read Pam Green's article Don't buy a Bouvier?

YesNo

Are you willing to spay/neuter your dog?

YesNo

Why Not?

Are you willing to take your dog to obedience classes?

YesNo

Please Explain:

Where will your dog stay during the day?

Where will your dog stay at night?

Where will your dog stay when left alone?

How much time will you spend with your dog each day?

How much time will your dog be left alone each day?

How will your dog be exercised?

How will your dog be socialized?

Are you aware of the exercise, grooming and tranining requirements for Bouviers?

YesNo

Are you committed to caring for this dog for its lifetime?

YesNo

Your Pets Past and Present

Have you owned a Bouvier before?

YesNo - Why have you chosen the Bouvier breed?

Please specify:

Have you owned dog(s) previously?

YesNo

Please specify breed, age, cause of death, etc.

Where did you get your dogs from? Select all that apply.

BreederGiftPet StoreRescue/ShelterStrayOther

Do you currently have other pets?

YesNo

Please specify pet, breed, age, male/female, spayed/neutered/in tact, etc.

Have you ever surrendered an animal to a rescue or shelter?

YesNo

Please explain:

Have you ever had to euthanize a dog?

Yes (please describe circumstances)No

Please describe circumstance(s)

Have you ever returned a dog to a breeder?

Yes (please describe circumstances)No

Please describe circumstance(s)

Family Environment

Are you Married or Single?

MarriedSingle

The Adult age(s) living in the home?

Between 18 and 30Between 31 and 60Over 61

Do you have children living at home?

YesNo

Please specify number of children and their ages:

Who in the home will be responsible for the dogs care?

Are all family members in agreement about acquiring a Bouvier?

YesNo

Please provide details:

Anyone at home allergic to dogs?

YesNo

Please provide specifics:

Anyone living at home smoke?

YesNo

Where do you live?

CityCountrySmall Town

Do you live in a house or apartment/condo?

ApartmentCondoHouseTownhouse

Do you rent or own your home?

RentOwn

Do you have written permission from your landlord to have a large dog?YesNo

Do you have a fenced yard?

YesNo

References

Do you currently have a vet?

Yes (please provide details)No

Please provide contact information including your vet's name, address, and phone number.

How long have you used this vet?

Please provide two personal references.

Please provide contact information including name, address, phone number and email address for each reference.

How long have you know each reference?

Additional Information

Please provide any additional information that would help us in selecting the right dog for you and your family.

Please enter the characters you see in this picture:

Characters

This helps prevent automated form submissions. If you are not sure what the characters are, make your best guess.

Completion of this questionnaire does not guarantee a puppy.