Information we would like about You.
Your name:
Your email address:
Your phone number:
Your Address:
Emergency Contact Person:
Emergency Contacts phone:
Other pets in the home:
Ages of those in the home:
Current Vet:
How you found Chai
Allergies in the family?
Looking for male or female?
Questions or Comments:

If Interested in a pup please fill our this questionnaire and
make an appointment to come visit with us.

If for any reason this questionnaire doesn't
work please include the information asked
for in an email