Adoption Questionnaire | Dog Harmony, Inc.

Your information:

First Name *

Last Name *

Email Address *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Do you own or rent? *OwnRent

Phone Number *

About your household:

Have you owned a dog before? *Yes, but not currentlyYes, I currently have a dogNo

What kind of dog do you currently have? *

Dog's Weight in Pounds: *

Dog's Age *

Do you have children or elderly people in the household? *

NoChildren under 8yrsChildren 8yrs and olderElderly

Do you have cats or other animals in the household? *

NoCatsOther

What other animals are in the house? *

My dog will primarily be: *An indoor dogAn outdoor dog

How many hours a day will your dog spend outside? *

How many hours will your dog spend alone each day? *

When I'm gone my dog will be: *In a crate in the houseLoose in the houseIn the yard

When I am home I want my dog to be by my side: *The majority of the timeSome of the timeI don't want my dog by my side

What kind of collar/harness will your dog use? *HarnessSimple leash and collarPinch collar

Please let us know the kind of dog you are looking for:

I want a guard dog: *YesNo

I want my dog to hunt or heard with me: *YesNo

I want my dog to be enthusiastic in the way it loves people: *VerySomewhatNot at all

I want my dog to be playful: *VerySomewhatNot at all

I want my dog to be laid back: *VerySomewhatNot at all

I am comfortable doing manner correction training: *VerySomewhatNot at all

I want to participate in Agility, Flyball, or Obedience classes with my dog: *YesNo

I'm interested in a dog with special needs (medical or behavioral): *YesNoPossibly

It is most important to me that my dog: *

Please prodide us with current or former veterinary clinic information:

Veterinarian's First Name

Veterinarian's Last Name

Clinic Name

Clinic Phone

Please provide two personal references:

First Name *

Last Name *

Phone *

Relationshp *

First Name *

Last Name *

Phone *

Relationshp *

Your information:

About your household:

Do you have children or elderly people in the household? *

Do you have cats or other animals in the household? *

Please let us know the kind of dog you are looking for:

Please prodide us with current or former veterinary clinic information:

Please provide two personal references:

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *

Has you dog been around other dogs? *

Training Information

Has your dog had training before? *

Payment

Your Information

Veterinary Information

Has your dog been spayed/neutered? *