CK Customer Survey

E-mail address (if online):

Name of Dog(s):

Month/Year Acquired: January February March April May June July August September October November December Do Not Remember 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Size of dog in weight (and height at back of neck if known):

Name of Sire (if known):

Name of Dam (if known):

Specific Personality Traits (please list details of any traits you mark "yes" to below):

Have you observed aggressive behaviors from your dog?
Yes   No  

Have you observed shyness or timid behaviors from your dog?
Yes   No  

Other Personality Traits (please describe the overall nature of your dog):

Specific Health Issues (please list details of any conditions you mark "yes" to below):

Has your dog experienced any problems with allergies?  
Yes  No   

Has anyone in your family experienced any problems with allergies to your dog?
Yes   No  

Has your dog experienced any problems with his or her eyes? (I.e. Excessive tearing, cataracts)
Yes   No  

Has your dog experienced any problems with his or her knees?
Yes   No  

Has your dog experienced any problems with his or her hips?
Yes   No  

Other Health Issues (please list any condition outside of normal good health and what treatments, if any, have been used to treat or correct the condition):

Comments (please include your feelings about the overall experience of adding a CK pup to your family):

May we quote you on your comments?   Yes   No

Due to excessive spam submissions, our online form submission option has been temporarily disabled.

To submit, please send as an attachment to email address: ckpuppies@aol.com or fax to: (530) 899-8980

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