Elaine Bartlett's
Brittany Questionnaire Page


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.


Form Rules: You may use the TAB key to move from field to field. You may use the ENTER key in text boxes ONLY...any other time you hit the ENTER key...the form will be sent. If you accidentally send the form, hit the back button and continue filling out the form and send it when you are finished. I will email you when I receive the form. If you do not hear from me within 48 hours, I may not have received your form. Please email me and send a new form. You can also email me (gonorthbrittanys@yahoo.com) if you have any questions.


Your Contact Information:

Today's Date:

Your name:

Your address:

City, State Zip

Your home phone number:
Don't forget your area code.

Your work phone number:
Don't forget your area code.

Your cell phone number:
Don't forget your area code.

Your e-mail address:

How would you prefer I contact you?
Home Phone
Work Phone
Cell Phone
OR
Email

If by phone...what time would you prefer I call?

What time zone are you in?

If you have a website address, please put that info here:


Your Puppy/Dog Preferences:

Are you interested in a particular puppy/dog on my site?
Yes OR No
Name of puppy/dog.

What sex puppy/dog are you looking for?
Male
Female
Either

If you have a preference, why this particular sex?

If your preferred sex is NOT available, are you interested in getting a puppy/dog of the other sex?
Yes
No
I'm not sure

This breeding is between an orange/white and a liver/white and the possible colors are: orange/white or white/orange, liver/white or white/liver, and possibly tri-color (tri-color is a liver/white dog with orange markings)
What color puppy/dog are you looking for?
You MAY choose more than one. If you have a MORE preferred color, let me know in the text box below.
Orange and White
Liver and White
Tri Color Understand that a Tri Colored Brittany is NOT a preferred color per the AKC Breed Standard and Tri Color puppies will be sold with a spay/neuter contract and with LIMITED AKC Registration. Tri Colors are NOT breeding/show prospects (unless I decide they are of superb quality).
My MOST preferred color is:

What age puppy/dog are you looking for?

Is this puppy/dog for yourself or another member of your household?
Yes OR No
If NO, who is the puppy/dog for?

Is this puppy/dog for a surprise gift?
Yes OR No

What are your plans for this puppy/dog?
Check ALL that apply.
Pet/Companion
Breeding Prospect
Conformation Show Prospect
Field Trial Prospect
Hunt Test Prospect
Hunting Prospect
Agility Prospect
Obedience Prospect
Rally Prospect
Tracking Prospect
Nose Work Prospect
Search and Rescue Prospect
Therapy Work Prospect
Other
If OTHER, please describe.

Are you planning to take this puppy to puppy/obedience classes?
Yes OR No


Your Dog History:

Have you ever owned a dog before?
Yes OR No

How long ago?

If YES to above question...have you ever owned a Brittany before?
Yes OR No

How long ago?

Have you ever raised a puppy before?
Yes OR No

If yes, what breed?

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 OR No
If YES, when and why?

Why are you interested in getting a Brittany at this time?

ALL of my puppies are sold on contracts. My contract states that I'm willing to take a puppy back at any time for any reason. However:
Have you thought about what arrangements you would make for the puppy should your life change and you could no longer care for the dog?


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 OR No
If YES, please describe?

What type of home do you live in?

If OTHER, please describe?

How long have you been in this home?
months OR years

Do you... own OR rent

If you RENT, do you have your landlord's permission to keep this type of dog?
Yes OR No
If NO, what are your plans to resolve this?

May I speak with your landlord?
Yes OR No

Landlord's name:
Landlord's phone:

Do you have a fenced yard?
Yes OR No
If YES, yes please describe the type (chain link, wooden) and the height.

Do you have a separate kennel run for the dog?
Yes OR No
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?

If OTHER, please describe?

How will the puppy/dog spend the night?

If OTHER, please describe?


Last Little Bit:

Would you be willing to let me visit your home by appointment?
Yes OR No

Are you over 18 years old?
Yes OR No
If NO, do you have your parent's permission and support in getting this dog?
Yes OR No
Please list your parent's name and phone number here.

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: