Your Name *
Email Address *
Spouse's Name
Address *
City *
Zip *
Home Phone *
Occupation *
Your Employer
Employer's Phone
Spouse's Occupation
Spouse's Employer
Spouse's Employer's Phone
Your Age *
Are you expecting a child or planning a family? Yes
Does your or your spouse's job require frequent out of town travel? Yes
Are you or your spouse subject to relocation? Yes
Are you a student? Yes
If 'yes' anticipated date of graduation:
Are you in the military? Yes
If 'yes' anticipated date of discharge:
How many children are living at home?
List ages of all children included above:
Besides your immediate family, are there others residing in your home? Yes
Number of other residents:
Relationship of other residents
Is anyone in your home allergic to animals?
Does anyone have asthma? Yes
Do you own or rent? Own
If you rent, please provide name and phone number of your landlord:
How long have you lived at your current address?
If less than two years, please provide your previous address:
Does your home have a yard? Yes
Does fencing completely enclose the yard for the dog Yes
If not, explain how and where you will allow the dog to exercise and relieve itself:
If your yard is fenced please describe what kind?
What is the height of the gate?
Can strangers gain access to your yard from the street? Yes
Do you have other pets at this time? Yes
If 'yes' are they spayed or neutered yet? Yes
If 'yes' are they indoor or outdoor? Indoor
Please describe your pets in detail including gender:
What pet food are you feeding your pet(s)?
If you have owned pets in the past and do not now, what happened to them?
Have you ever owned a Doberman before? Yes
Are you looking for primarily an indoor dog or primarily an outdoor dog? Indoor
What role you would like your new Doberman to play in your life?
Please describe where the dog will stay when you are at home:
Please describe where the dog will stay when you are away:
Please describe where the dog will sleep at night:
How many hours per day will the dog be alone?
Do you have a crate? Yes
If 'yes', how many hours per day will the dog be crated?
Do you plan to use a crate? Why or why not?
Do you currently have a dog door? Yes
What kinds of solutions would you be willing to try if housebreaking accidents occurred? {please check all that apply} Crate
Dog Door
Leave Outside
None, I would need to return the dog
Other (please specify)
Have you ever trained a dog before? Yes
If 'yes' please describe the training methods you have used in the past:
Are you familiar with the signs of gastric torsion [bloat]? Yes
Please provide us with your current veterinarian information {required}: *
If less than five years please provide us with your previous veterinarian information:
Please provide three references not related to you:
Do you have a gender preference? Male
No Preference
Please tell us the what age range you will consider:
If you were referred by anyone, please tell us so we may thank them:
Please give us any other information that may help us make the best match between you and your new Doberman: