Potential Puppy Questionnaire

Name (required):
Address (required):
City (required):
Province/State (required):
Postal Code/Zip (required):
Home Phone (required):
Work Phone:
Email Address (required):
Occupation:

Have you ever owned a Portuguese Water Dog before?
Do you prefer a -

• Male
• Female
• Undecided

Why have you decided to purchase this particular breed?
What type of personality are you looking for in your puppy?
Do all family members agree to the purchase of this puppy?
Do you have young children?
If so, what ages?
Do you currently own any other dogs?
If yes, please list breeds, sex and ages
Do you own other pets?
If yes, what type(s)
Do you Own or Rent
Do you live in a -

• House
• Apt
• Other

Do you have a securely fenced yard?
Do you have a kennel run?
Do you own a crate?
Where will your PWD be kept during the day?

• House
• Kennel run w/doghouse
• Yard w/doghouse
• Combination
• Other

Where will your PWD be kept at night?

• House
• Kennel run w/doghouse
• Yard w/doghouse
• Combination
• Other

For what purpose(s) are you purchasing a PWD (Rank all that apply by number) -

• Family
• Pet
• Obedience
• Show
• Agility
• CKC Tracking
• Other

Are you willing to spay/neuter this dog?
If not, why?
Have you ever had a dog euthanized?
If yes, why:
Do you have a regular vet?
If yes, please list his/her name, address and phone number:
How did you hear about us?
List 2 references including name, address, email, phone, relationship to you, years known:
Do you have any additional comments or concerns: