Puppy Questionnaire

Your Information (Fields with yellow labels are required fields)

Name:

Address:

City:

Province or State:

Postal/Zip Code:

Country:

Phone Number:

What kind of information are you interested in?:

General Breed Information
Puppy Availability
Rescue Information

Please indicate your area of interest:

Show/conformation
Obedience/Agility
Breeding
Guard dog
Pet/companion

Do you currently own an Akita?

Yes
No

If yes,

# of Males:

# of Females:

# Neutered:
# Spayed:

Have you owned an Akita in the past?

Yes
No

If yes, please tell us about your Akita. Include how you acquired the
dog, who you acquired it from, when & how long you owned it & what has
happened to it:

Do you currently own any other animals?

Yes
No

If yes, please tell us what type of animals you own, what breed if it's a dog,
how long you've owned them & whether or not any of them have been spayed
or neutered:

If you are inquiring about the availability of a dog please complete the following:

Are you interested in a:
Puppy
Older Puppy/Adolescent

Are you looking for specific coat color?
Yes What color?
No

These are my preferences, but I would consider a healthy puppy of another color.
I only want a puppy of the color combination I indicated.

Gender:
Male
Female
Either

Additional information:

Do you live in a house or an apartment?
House
Apartment

Do you own your home?
Yes
No

Are you willing to travel to pick up the puppy?
Yes
No

Do you have a backyard with a fence that is at least 6 feet tall?
Yes
No

Will the dog be kept inside or outside the house most of the time?
Inside
Outside

Will you crate train your puppy?
Yes
No

Will you house train your puppy?
Yes
No

Have you ever had to euthanize a dog ?
Yes
No

How have you been referred to us?

What qualities do you like to see in an Akita?

Do you currently have a veterinarian that is familiar with you?
Yes
No

If yes would allow me to contact them?
Yes
No

Do you commit to taking care of this dog for it's entire life??
Yes
No

Do you have any children?
Yes
No

If yes, What are their ages?

If you are purchasing a pet, will you agree to sign a contract
stating that the dog is to be spayed or neutered and not to be
used for breeding purposes?
Yes
No

Please tell us why you have decided you want an Akita:

Do you have any questions or comments you'd like to share with us?