Name *

First Name

Last Name

Phone *

(###)

###

####

What is your dog's birthday? *

MM

DD

YYYY

Which hereditary defect is affecting your dog? *

Not all hereditary diseases are able to be tested for and are not included in the health guarantee.

Hip Dysplasia

Urinary Bladder Stones

Epilepsy

Heart Disease

Liver or Kidney Disease

Degenerative Myelopathy

Progressive Retinal Atrophy

Osteochondritis Dissecans

Hypothyroidism

Addison’s Disease

Other

Did your dog receive a vet checkup within 72 hours of getting home? *

Yes

No

Was your dog Spayed/Neutered by 1 year of age? *

Yes

No

Has your dog been kept up to date on vaccines throughout his/her life? *

Yes

No

Was your dog Euthanized? *

If so, did you receive a second opinion from our preferred veterinarian before proceding with the decision to euthanize?

Yes, I received a second opinion from My Doodle Puppy's preferred veterinarian

Yes, I did NOT receive a second opinion from My Doodle Puppy's preferred veterinarian

No, my dog is still living

Which remedy would you prefer? *

Remedy 1: Return your dog for a refund

Remedy 2: Return your dog for another puppy of equal value