| If you are interested in one of our puppies, please fill up and return this questionnaire. |
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| The Eklectic Maltese |
| Copyright 2010 |
| The Eklectic Maltese |
| If you are interested in one of our puppies, please fill up and return this questionnaire. |
| If you are interested in one of our puppies, please copy and paste here |
| Prospective New Owner Questionnaire |
| Your name:_______________________________________ Your address:_____________________________________ _____________________________________ Your phone #:_____________________________________ How long have you lived at this address? _____________ Do you rent or own your home? Rent ______ Own ____ If renting, does your lease permit pets? _________________________Yes ____No Are you prepared to provide confirmation that your lease permits pets? _____Yes ____No Landlord Information: Name: _______________________________ Address _______________________________ Phone # _______________________________ Do you have family members whose age or physical limitations may constitute a risk to the safety of a Maltese puppy? _____________________________________________________________________________ Is everyone in your house in agreement with buying a new puppy? ________ Will this be your first Maltese? ________ What other pets live in your home? ______________________ What are their species/breeds/ages, and are they intact or spayed/neutered _____________________________________________ What kind of research have you conducted about this breed? (check all that apply) _____Websearch _____Internet _____ Friends (other Maltese owners) _____Books (Literature) _____Other (Other – specify) What do you expect the activity level of this breed to be? Very high, High, Moderate, Low Have you ever? Owned a dog Yes No Housetrained a puppy Yes No Raised a puppy Yes No Attended obedience classes Yes No Have you ever had to give up a puppy? Yes No If yes, what were the circumstances and who did you give the puppy/dog to? ______________________________________________________ Have you ever returned a pet to the Breeder Yes No If yes, what were the circumstances and why? _____________________________________________________________________________ Have you ever taken a pet to a shelter or pound Yes No If yes, what were the circumstances? ________________________________________________________ Do you have a Veterinarian? Please give your Veterinarian information Name:____________________________________________________ Address:__________________________________________________ Phone # __________ How long have you been a client of the Veterinarian? Will you agree to inform me of any serious health or medical conditions that occur with your puppy? – Yes No Have you looked into the pricing of food, grooming aids, etc required for, that is required for a Maltese?- Yes No Who will be the primary care giver of this puppy? _________________ What hours will the puppy be left at home alone? ___am to ____ pm Are you able to return home from work during the day/night to feed and exercise the puppy? __ Yes __ No Where will the puppy be kept during the night? _______________________ Where will the puppy be kept during the day? _____________________________ Is your yard fenced? __ Yes __ No If yes, does it have any holes at the bottom of the fencing that the puppy could squeeze through? - Yes No Do you have an in ground pool? __ Yes __ No If yes, is it properly fenced so that the puppy cannot fall into the pool? __ Yes __ No Will you be supervising the puppy at all times when it is outside? __ Yes __ No Are you willing to attend obedience classes to train the puppy? __ Yes __ No Did you know that the average life expectancy of a Maltese is 14 years? __ Yes __No Are you willing to devote the time, energy and money to keep this puppy in good mental, physical and emotional health? - Yes No Will you agree to confine your puppy to a crate, indoor exercise pen, or puppy proofed room so that the puppy is protected from eating any objects or getting into anything that will cause harm to the puppy when you are not supervising the puppy? - Yes No Do you agree to allow your puppy to have several short periods of playtime each and every day ?- Yes No Do you understand that owning a puppy/dog is a lifetime commitment?- Yes No Do you understand that you should not yell at or physically punish a puppy/dog, but instead calmly discipline in a positive way? - Yes No Do you agree to spay/neuter this puppy at the earliest when your veterinarian deems it safe or at 10 months of age? - Yes No To sign a contract that this puppy is to be spayed/neutered at the earliest when your veterinarian deems it safe or at 10 months of age? - Yes No Do you agree to follow the recognized puppy vaccination schedule or that proscribed by your municipality? To follow this puppy vaccination schedule? - Yes No Do you agree to take your puppy to the vet whenever the puppy shows signs of illness, lameness, pain, or any other problem? - Yes No Do you understand and agree that by signing this contract you will not be allowed or permitted to resell, lease or place your puppy, but will have to return it to, if for some reason you are unable to take care of it? - Yes No My Declaration as a Breeder: I MUST ALWAYS THINK OF MY PUPPY’S SAFETY AND WELFARE AND THAT WILL ALWAYS BE MY FIRST PRIORITY AS A BREEDER. PLEASE UNDERSTAND THAT I WILL BE COMMITTED TO YOU AND THIS PUPPY, AND WILL BE WILLING TO ANSWER QUESTIONS AND GIVE ADVICE FOR THE LIFETIME OF THE PUPPY. I __________________________ have read and answered this questionnaire honestly and to the best of my ability. I understand that by answering these questions, I am not guaranteed to purchase a puppy or to be put on the waiting list. I also understand that the breeder will contact me to let me know whether I am accepted as a puppy owner prospect. Signed this day of 20__ …………………………………… |