Report Sick Puppies (please)
Gathering information to identify PUPPY stores/breeders selling sick puppies to loving, caring, trusting individuals 

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Please complete this form in it's entirety.  I WILL NOT sell your information to ANYONE!  If you have any suggestions on how to improve this process or website, please e-mail me at info@ReportSickPuppies.com.  This data will be compiled and forwarded to the Department of Health.
Your Name: *
Puppy's Name: *
Your E-Mail: *
Contact # (optional):
Your Town: *
Zip Code: * (5 digits)
Breeder/Store Name: *
Breeder/Store Town *
Purchase Date: *
Breed: *
Date of Birth: *
Gender:: *
Deceased?: *
Vet Unfit for Sale Letter: *
Hereditary Problem?: *
Details of Sickness:
Other Information:

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