CAPS Complaint Form

Approve to Publish
YesNo
If you approve us to publish your complaint so that it will be visible to the general public on our website please check yes. Note that we will not publish personal/contact information about you, but we will publish your name.

About You

First Name*

Last Name*

Your Phone*

Your Email*

Address Line 1*

Address Line 2

City*

State or Province

Zip or Postal Code*

Country*
CanadaUnited StatesOther

How should we contact you?
E-mailPhone

About the Shop / Purchase

Was this an online purchase?
YesNo

Shop Address Line 1*

Shop Address Line 2

City*

State or Province

Zip or Postal Code*

Country*
CanadaUnited StatesOther

Name of shop country if other?

Shop Website

About the Companion Animal

Date of Purchase*

Price (if known)

Breed*

Sex*
FemaleMale

Date of Birth*

Date of Death (if applicable)

About the Breeder

It will help CAPS immeasurably in our investigation if you provide information about the breeder and broker. It should be documented in your paperwork. Look on your purchase papers and pedigree, if applicable.

Breeder Address Line 1

Breeder Address Line 2

Breeder City

Breeder State or Province

Breeder Zip or Postal Code

Breeder Country
CanadaUnited StatesOther

If Breeder Country Other

Breeder Phone

Breeder Email

Breeder Website

About the Broker

Broker Address Line 1

Broker Address Line 2

Broker City

Broker State or Province

Broker Zip or Postal Code

Broker Country
CanadaUnited StatesOther

If Broker Country Other

Broker Phone

Broker Email

Broker Website

The Situation and Your Experience

Diseases and Illnesses*

When did illnesses begin and end?*

Did the pet shop or kennel recommend this vet?*

Veterinary expenses to date*

How did you hear about this pet shop, kennel or online merchant?*

Please describe the conditions in the pet shop or kennel, such as housing, space availability, food, water, bedding, cleanliness, temperature, health and demeanor of the animals, and exposure to illness and disease:

Pet Shop Complaint Form

Instructions