We strive to place our puppies in the perfect home for them. Please fill out this questionaire to help me sort out the best suitable puppy for your needs.

All information is sent directly to my personal email address and no information will be shared with any other parties. If you prefer please download this form HERE in MS Word format and email it to me at cherokee@flatcoat.net

First & Last Name

E-mail Address

Street Address

City

Select Your State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas U.S. Virgin Islands Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Zipcode

How long at this Address?

Day Phone Number

Evening Phone Number

Type of Dwelling
House
Condo
Apartment
Mobile Home

Do you Rent or Own
Rent
Own

Have you owned a dog before?
Yes, I have owned
No, will be first pet

If Yes, What types and how long did you have them?

What type and brand of dog food do you plan to feed?

Do you have Children under age 18?
Yes, I have children under 18
No, I don't or they are all grown

If So, how many and what are their ages?

Is anyone in your family allergic to animals?
Yes
No

Select Your Interests
Agility
Field/Hunting
Pet
Obedience
Tracking
Therapy Dog
Conformation
Other (specify in comments)

Do you prefer a male or female?
Male
Female
No Preference

Do you plan on taking your puppy to obedience classes?
Yes
No

Do you have a fenced in yard?
Yes
No
No, but will put one up

If yes, how tall and large is fence?

If no, how will dog be exercised?

Are you aware of the hereditary health problems that can affect Flat-Coated Retrievers? If not, please call so we can discuss.
Yes
No

What activity level are you wanting your puppy to have from a scale of 1-10. (1 being the least active)

How many Flat-coat owners do you know?

Please give us the name and address of your Veterinarian

Please provide us with the names and contact information for 3 references below

Reference #1

Reference #2

Reference #3

Comments