Questionnaire

ABOUT YOU

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Please tell us a little about you *

YOUR HOME

What type of home do you live in? (House, Apartment, etc.) *

Do you own or rent? *

Own Rent

If you rent, does your lease allow dogs? If not, please explain how you plan to work this out. *

How much land do you own? *

Do you plan on relocating any time soon? *

What type of area do you live in? *

Do you have a fenced in yard? *

If you have a fenced yard, what type is it and how high is it? *

Where will your Aussie sleep? *

What is your occupation? *

When you are not home, where will you keep him/her during this time? *

On average, how many hours a day will your Aussie be left alone? *

Describe a typical week in your household: *

PETS

Number of adults living in your home: *

Number of children living in your home (With ages): *

Who will be the primary care giver of this dog? *

Do you plan on getting another puppy at the same time, or in the near future? *

Do you currently have any pets? *

Yes No

If yes, how many and what type/breed and ages *

Have you owned dogs in the past? *

Yes No

If yes, what breed, and where are they now? *

Has anyone in your home ever been convicted of a crime against an animal? *

Has there ever been a problem with one of your children and animals before? If yes, please explain: *

Have you ever taken a dog to a shelter, back to its breeder or to a rescue? If yes, what were the circumstances? *

ABOUT THE AUSSIE

REFERENCES

Reference #1

Name, Address, Phone, Email, Relation to you *

Reference #2

Name, Address, Phone, Email, Relation to you *

General Questions / Information

Any other helpful information you would like us to know or questions you have for us: *

Mercury Australian Shepherds Puppy Questionnaire