The Name of Your Dog: Mother's Name: Mitty Muffin Carney Cinnamon Berrie Mia Sunny Angie Daisy Spicey Sara Duckie Nickie Genny Mallary Date of Birth:

Your Name: Telephone #:

Your Address:      Email Address: 

Health

What is the general health of your dog?

Please describe any abnormalities:

How much does the dog weigh?

Has the dog been neutered? Yes No  

    If No, has the dog been bred? Yes No How many litters?How many puppies?

Your Veterinarian's Name:Phone #

If the dog is deceased, date of death:Cause of death:

Appearance

Characterize the dog's coat: Smooth Wavy Curly Other (describe below) Color: Very light golden Light golden Medium golden Dark golden

Coat texture: Soft Light Dense Coarse Other (describe below)

Has the dog been shown? Yes No If Yes, any points or championships:

Temperament

Describe the dog's temperament:

How does the dog get along with other dogs, cats, etc.?

Describe any formal/informal training dog has had:

List any obedience titles or certificates dog has earned:

Environment

What food do you feed the dog?

What water do you provide? Well water City water Bottled water Creek/pond water

Describe the exercise routine for the dog:

Any comments, questions, concerns:

Thank you for your participation.  

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