Elaine Bartlett’s
Brittany Purchase Questionnaire
P O Box 233868
Anchorage, AK99523-3868
(907) 561-0405
Anyone interested in getting a puppy/dog or on the puppy waiting list, must fill out a questionnaire. This questionnaire helps me to make sure my Brittany puppies and you would be a good match. It also helps me to know what questions to ask during our face-to-face or phone interview. This questionnaire is the first step. Some of the questions may seem silly...some may seem intrusive. Please remember that I'm not trying to pry. I'm just trying to make sure the puppies I help to bring into the world go into the best possible homes
Your Contact Information:
Today's Date: ______
Your name: ______
Your address: ______
______
City, State Zip
Your phone number: ______
Don't forget your area code.
Your e-mail address: ______
How would you prefer I contact you? Phone OREmail
If by phone...what time would you prefer I call? ______
What time zone are you in? Eastern, Central, Mountain, Pacific, OR Other
If OTHER, what time zone? ______
Your Puppy/Dog Preferences:
Are you interested in a particular puppy/dog on my site? Yes ORNo
Name of puppy/dog. ______
What sex puppy/dog are you looking for? Male OR Female OR Either
If your chosen sex is NOT available, are you interested in getting a puppy/dog of the other sex?Yes ORNoOR Not Sure
What color puppy/dog are you looking for?
You MAY choose more than one. Number them if you have an order of preference.
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□Orange and White
□Liver and White
□Orange Roan
□Liver Roan
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□Tri Color Understand that a Tri Colored Brittany is NOT a preferred color per the AKC Breed Standard and all Tri Color puppies will be sold with a spay/neuter contract and with LIMITED AKC Registration. Tri Colors are NOT breeding/show prospects.
What age puppy/dog are you looking for?
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□Not Sure
□Under 3 Months old
□Under 6 Months old
□Under 1 year old
□1-3 years old
□Over 3 years old
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Is this puppy/dog for yourself or another member of your household?Yes ORNo
If NO, who is the puppy/dog for? ______
Is this puppy/dog for a surprise gift? Yes ORNo
What are your plans for this puppy/dog?
Check ALL that apply.
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□Pet/Companion
□Breeding Prospect
□Confirmation Show Prospect
□Hunting Prospect
□Agility Prospect
□Obedience Prospect
□Other
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If OTHER, please describe.
Your Dog History:
Have you ever owned a dog before? Yes ORNo
How long ago?
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□I've never owned a dog.
□I own dog(s) now.
□When I was a child.
□Less than a year ago.
□More than a year ago, but less than 5 years ago.
□Over 5 years ago.
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If YES to above question...have you ever owned a Brittany before? Yes ORNo
How long ago?
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□I've never owned a Brittany.
□I own a Brittany(s) now.
□When I was a child.
□Less than a year ago.
□More than a year ago, but less than 5 years ago.
□Over 5 years ago.
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In the area below, please, tell me about any pets you CURRENTLY have including type (dog, cat, gold fish...etc.) / breed / sex / age, or anything else you think would be helpful.
Please tell me about any pets you've had in the past 5 years, but no longer own. What happened to them?
Have you (in the past 5 years)given a dog away, returned a dog to the breeder, or turned a dog over to a shelter or rescue group? Yes ORNo
If YES, when and why?
Why are you interested in getting a Brittany at this time?
Your Home Environment:
In the area below, please, tell me about the members of your household. Please list all adults, and the sex and ages of all children.
Are you planning to add other members or pets to your household (someone moving in, birth of a child, getting a cat) in the near future?Yes ORNo
If YES, please describe.
What type of home do you live in?
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□House
□Apartment
□Trailer/Mobile Home
□Other
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If OTHER, please describe?
How long have you been in this home? ______months OR years
Do you… own ORrent
If you RENT, do you have your landlord's permission to keep this type of dog?
Yes ORNo
If NO, what are your plans to resolve this?
May I speak with your landlord?Yes ORNo
Landlord's name: ______
Landlord's phone: ______
Do you have a fenced yard? Yes ORNo
If YES, yes please describe the type (chain link, wooden) and the height.
Do you have a separate kennel run for the dog?Yes ORNo
If YES, yes please describe the type, height, and flooring.
If you do not have a fenced yard or kennel, how will you handle the dog's exercise and toilet duties?
How the puppy/dog will spend an average day:
How many hours (in the average day) will the puppy/dog spend alone? ______
Where will the puppy/dog spend most of the day?
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□loose indoors
□confined to part of the house
□loose in fenced yard
□kennel run
□garage
□basement
□loose outdoors (no fence)
□tied in yard
□crate
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If OTHER, please describe?
How will the puppy/dog spend the night?
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□loose indoors
□confined to part of the house
□loose in fenced yard
□kennel run
□garage
□basement
□loose outdoors (no fence)
□tied in yard
□crate
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If OTHER, please describe?
Last Little Bit:
Would you be willing to let me visit your home by appointment?Yes ORNo
Are you over 18 years old? Yes ORNo
If NO, do you have your parent's permission and support in getting this dog? Yes ORNo
Parent’s name: ______
Parent's phone: ______
Please list at least one personal reference. Include a name and phone number for each.
Thank you so much for filling out this questionnaire. I know it's a little lengthy, but it really helps me in placing puppies into compatible homes.
Please add any comments you have below:
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