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                State:  (2 characters)    Zip code:  (min 5, max 20 characters)

      Home Phone:    Work Phone:  (min 10 characters)

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Occupation:

1. Why have you decided to buy a Samoyed?

2. Have you ever owned a Samoyed before? If so how did you obtain it? Breeder (who) Pet shop, Animal shelter?  Please give me a little history of it ( temperament, health problems?)

3. What kind of research have you done on the Samoyed? Please give me a brief Idea of your Knowledge (books read, website, those types of things)

4. What other breeds have you owned in the past?

5. Do you currently have any other animals? If yes please list them, including type of animal, sex of animal, age and whether they have been spayed or neutered.

6. Have you ever had to put an animal to sleep? If yes please give Circumstances.

7. Have you ever had a dog die of Major health problems (cancer, bloat, etc)? Please explain situation.

8. Have you ever had a dog that had any health problems that they didn’t die from? (Allergies)

9. Are you looking for a puppy or an older dog?

10. Do you prefer a Male or Female? Why

11. If the sex you prefer isn’t available would you consider a puppy of the opposite sex?

12. Who is this puppy mainly for? Family Pet Relative Children A friend The Adults

13. Do you have any children? If not do you plan on having them in the future? Please list ages.

14. Does anyone in your family have any type of allergies to dogs or animal dandruff?

15. Do all family members agree that they want a puppy and are willing to share the chores of taking care of a puppy?

16. Please describe your family and how a typical day runs at you house.

17. Please tell us what type of activities you are looking for in a Samoyed. (Couch potato, jogging companion, buddy for kids, hiking, riding companion, etc.)

18. Are you willing to take this puppy to Puppy Kindergarten classes and Obedience classes? Yes No

     If yes what type of class and where (are they all positive classes?)

19. Do you plan to do any other activities with the puppy? (Agility, Flyball, Pet Therapy, Hiking, Herding, Please List Others)

20. Do you rent or own your house? If you rent does you landlord approve of you getting a puppy and the breed?

21. Do you have a fenced area that the puppy could go out into? Or a kennel run. If not would you be willing to put one up? Is it dig proof?

22. Are you willing to have this puppy Spayed after her first heat cycle or for a male neutered at One year and no later than 1 year 3 months?  Yes No

23. Are you looking for an "Outdoor Dog"? Or a dog that lives and sleeps inside?  Outdoor Dog Inside Dog

24. Are you aware and have no problems with the fact that Samoyed do shed and you will probably have to vacuum once a week or every other week? Also are you willing to deal with the grooming and vacuuming that is required when a Samoyed does a full blown shed 2 times a year?  Yes No

25. Do you have a grooming situation in place for this puppy? (A groomer, yourself?) Do you need help or would you like to learn how to do it yourself? 

26. Do you plan on feeding Kibble or would you considering feeding a raw diet if you were given the information?

27. Do you have a Swimming Pool, pond, lake, open well or any other open bodies of water on you land?

Is that area fenced? Yes No

28. Where will your puppy be during the day while you are at work(if you work) or when you go away for a few hours?

29. Besides having a fenced area will you do other exercise with the puppy on a daily basis? (walk, jog, hiking,

     running)

30. What is the name of the Veterinarian and Clinic that you will be using? Have you used this vet before? May 

we contact them for a reference if desired?

31. Ok here is your chance to tell us anything else that you believe we should know!!!