Puppy Questionnaire
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Home Phone Number
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| Cell Phone Number
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| Email
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| Website
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| Your Occupation
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| Spouses Occupation
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| Additional information about yourself/family
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| Do you have children, and if so what are their ages and genders?
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| Do you own or rent your principal residence?
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| What type of dwelling do you reside in?
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| If renting, do you have your landlord's permission to have a golden retriever? And please provide landlord's contact info.
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| Are there covenant restrictions on owning a dog in your neighborhood?
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| Do you have a fenced in yard? If so, please describe fencing and yard size.
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| Do you have gates that can be securely locked?
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Yes No
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| Is there outside shelter for a dog?
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Yes No
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| Where will the dog be housed during the day and during the night?
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House/Crate in house Dog run with dog house Yard with dog house
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| Do all family members want a new puppy?
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Yes No
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| Do you currently own a dog? Please describe type/breed/ages.
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| Do you have any other pets? Please describe type/breed/ages.
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| Are you committed to care for this dog's needs for his/her lifetime?
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Yes No
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| Will there be people at home during the day to house train & care for a new puppy? If no, what arrangements will you be making for this new puppy?
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| Who will be the primary care giver of the puppy?
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| Have you ever crate trained a puppy or dog?
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Yes No
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| Are you willing to take this dog to obedience classes so that he/she will become an enjoyable companion and an integral part of your family?
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Yes No
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| If you ARE CONSIDERING breeding this dog, are you prepared to obtain all of the following necessary clearances before breeding? (OFA Hip & Elbow, CERF Eye, and SAS Heart)
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Yes No
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| Are you willing to spay/neuter this dog?
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Yes No
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| For what purpose are you looking for in your puppy (family companion, obedience, breeding, conformation, or field work)?
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| Do you prefer a male or a female?
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Male Female
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| What type of personality are you looking for in your puppy?
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| Have you ever returned a pet to the breeder? If so, what were the circumstances?
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| Have you ever given a pet away? If so, what were the circumstances?
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| References: Please provide 2 persons that we could contact for references. If possible, please include the name of your current veternary clinic
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Thank you so much for taking the time to complete this questionnaire. We strive to achieve the best placements for our puppies while making every effort to find that right puppy for you.
I understand that this application is just a beginning step in the interview process and it does not automatically entitle me to a dog. Submit when finish. We will contact you via Email as soon as possible regarding the availability of our puppies. ***Thank You***
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| Email
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EMF Web Form
EMF Web Form