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First Name*
Last Name*
Email Address*
Dogs*
Do you have dogs?*
(Do you have dogs?*)
No
Yes
Dog Name
Dog Age
(Years)
((Years))
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(Months)
((Months))
0
1
2
3
4
5
6
7
8
9
10
11
Dog Size
(Dog Size)
Toy
Small
Medium
Large
Giant
How did you acquire your dog?
(How did you acquire your dog?)
Breeder
Shelter
Pet Store
Friend/Family
Other
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