CMTC Breeder's Check-Up at fwaggle.com

Identification Please provide any/all of the identifying information in this section that is readily available. We will use the details provided to identify your dog and to update our records with your most current contact information.

Owner's Name(s):
Address:
Telephone:
Email:

Please provide any of the following identifying information you are aware of:

Dog’s Registered Name:
Registration No.:	Sex: Male Female
Date of Birth:
Sire:
Dam:

General Health If you have filled this form out previously (i.e., one or five years of age) you may choose to answer only those questions for which your responses have changed.

Medical History

Please list any physical conditions your dog has suffered from during his or her life and/or since the last time you filled in this survey:

No physical conditions to report

Disease Name*	Age at Onset	Diagnosed By**

*You may wish to refer to the list of dog-related conditions as a memory aid
**Diagnosed by: Self, veterinarian, breeder and using what type of test if applicable (i.e,. Baer, CERF, blood test)

Please use the space below to provide any additional information on the conditions listed above, including treatment options:

Temperament

Would you consider that your Manchester Terrier was easy to housebreak? Yes No
At what age would you have considered him/her reliably housebroken?

Please indicate below if your dog has or currently displays any of the following behaviours:

    Aggressiveness
    Excessive Shyness
    Excessive Fearfulness
    Fear Biting
    Submissive Urination
    Separation Anxiety

If you answered yes to any of the above, please provide more information on the problem (i.e., circumstances, impact on day-to-day activities, etc.). In the case of shyness and fearfulness please indicate if this is/was episodic and, if so, at what ages you noticed fear periods appear and disappear. Also keep in mind that the breed is naturally wary/distrustful of strangers -- did this behaviour fit within those parameters or were they more than you expected?

Mortality (if applicable)

Approximate Date of Death or Age:

Cause of Death:

Was cause of death diagnosed by a veterinarian? Yes No

Please use the space below to provide more information if necessary:

Breeder Evaluation
How well did your breeder help prepare you for the addition of a puppy to your home/family?

Excellent Good Neutral Fair Poor

Did he/she discuss the importance of socializing your puppy from a young age? Yes No

Did he/she suggest puppy kindergarten and/or obedience classes? Yes No

Did he/she provide you with sufficient information on the breed and its characteristics, both positive and negative?

Excellent Good Neutral Fair Poor

Overall, do you think your breeder helped you form reasonable expectations of life with a Manchester Terrier?
Yes No

If no, please explain which specific areas you feel more information should be provided on.

Did your breeder provide adequate aftercare (i.e., advice, etc.)? Yes No

Would you purchase a puppy from this breeder again? Yes No

Why/why not?

Final Comments

I encourage you to provide below any additional information you feel we, as breeders, should be aware of.

Would you purchase a Toy Manchester Terrier again? Yes No

Why/why not?

Was your dog spayed or neutered? If yes, at what age?	Yes No

What brand of dog food do you feed? How much does your dog weigh?
Would you consider him/her overweight?	Yes No

How would you characterize your dog's overall physical health? Excellent Good Fair Poor

How would you characterize your dog’s overall oral health? Excellent Good Fair Poor

How often do you brush your dog’s teeth? Once/day Once/week Once/month Less Often Never

Have your dog’s teeth been surgically cleaned by a veterinarian? Yes No
Were any teeth removed? If so, at what age? How many?	Yes No