**** GOLDEN RETRIEVERS

Puppy Buyer Questionnaire

Your assistance in completing this questionnaire will help us place the right puppy with you.
While it is not our intent to be intrusive, these questions help determine whether a Golden
Retriever is the right breed for you and to help ensure a good match. Furthermore, these
questions assist us in addressing subjects that may not have been previously discussed
If you feel additional information would be helpful, please add additional pages as necessary.
After completing this questionnaire, please return the information provided since it greatly helps
placing just the right puppy with you! Also, should you have any questions and/or concerns
about this questionnaire, feel free to contact us. All information is confidential. Thank you for
your interest in **** Golden Retrievers.
Name:_______________________________________________Date:_______________
Address:________________________________________________________________
City:___________________________________ State:_________ Zip Code:__________
Telephone (Home): ____________________ Cell or Work (specify):________________
E-mail:__________________________________________________________________
Occupation(s):____________________________________________________________
Full Time:__________ Part time:____________ Student:__________
List the names and ages of all members of your household:________________________

What other breeds are you considering at this time?______________________________

How did you first learn about the Golden Retriever?______________________________

________________________________________________________________________
Why does the Golden Retriever appeal to you?__________________________________

For what purpose do you wish to purchase a Golden? (Check as many as apply):
Companion_______ Show Dog________ Obedience________ Breeding___________
Field__________ Agility__________ Therapy _______ Flyball____________
Other___________________________________________________________________
Do you prefer a male____ or female____ puppy? Why?__________________________

Are any members of your household allergic to dogs and/or cats?___________________

Are there any members of your household who DO NOT want a new puppy?
________________________________________________________________________
Who in the household wants a puppy the most?__________________________________
Who in the household wants a puppy the least?__________________________________
Who will be the primary caregiver(s) of the puppy?______________________________

Are any of the caregiver(s) under the age of 18? _________________________________

Is your current residence a house_____ apartment______ condo_______ other_________
Do you own______ or rent_______ your residence?
If you rent, does your current lease permit you to have pets?_______________________
If you rent, does your current lease permit you to have large dogs?__________________
Would your landlord be willing to send us written confirmation that large breed dogs are
permitted? Yes_________ No_________
Please provide the name, address and phone number of your current landlord:_________

________________________________________________________________________
If you own, is there a Homeowners Association? Yes______ No________

If there is a Homeowners Association, do the covenants restrict large dogs?

Yes_____ No______
If there is a Homeowners Association, do the covenants restrict the number of animals
you may have? Yes_____ No______
Do you own other pets? Yes_____ No_____
How many pets reside in your household?__________
What type of pets do you have?______________________________________________
What are the ages of your other pets?__________________________________________
Have you ever owned a dog before? Yes____ No_____
If yes, what breed(s) or mixtures?_______________

________________________________________________________________________
Have you ever had to sell or give away a dog before? Yes_______ No________
If yes, what were the circumstances? __________________________________________

________________________________________________________________________
Please list all the dogs you have owned in the past ten years including the following information:
A) Breed
B) Where you obtained your dog(s)
C) Gender of dog and whether it was spayed or neutered
D) What became of the dog(s) (i.e. death, sale, gift, theft, etc.). If by death, please state the
cause of death and approximate age of dog at time of death.

_______________________________________________________________________

Does your current residence have a yard? Yes____ No_____

If yes, please state the general dimensions of your yard:___________________________
If you have a yard, how is it enclosed?_________________________________________

Where will your Golden puppy be kept during the day?___________________________

Where will your Golden puppy be kept during the evening?________________________

Where will your Golden puppy sleep?_________________________________________

What do you plan to do with the puppy when you go on vacation?___________________

How much time do you plan to spend with your Golden puppy on a typical weekday?

How much time do you plan to spend with your Golden puppy on a typical weekend?

Do you have any time-consuming hobbies or interests which you feel may affect the time
available to spend youre your Golden? If yes, please explain.

An adult Golden requires regular exercise. How do you plan to exercise your dog?

Are you willing to spend the time and money necessary for training and provide love, a healthy
diet, exercise and adequate medical care, shelter and grooming? The average life span of a
golden is 10-16 years.
Yes________ No_________
Do you have an established veterinarian? Yes_________ No_________
If yes, please provide the veterinarians name and telephone number:________________

If no, would you take a recommendation for a veterinarian in your area? Yes___ No___
What do you plan to feed this puppy?_________________________________________
Would you be willing to follow the breeders protocol on diet?______________________
Are you willing to take your Golden puppy through a formal class-oriented obedience program?
Yes_______ No________

Have you ever completed an AKC or UKC title on a dog in either conformation________
or obedience________ or other (specify)______________________________________.
Have you ever bred a litter of puppies or used your dog as a stud dog? Yes____No____
If yes, please state the number of times and all information pertaining to these breedings:

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
If you are considering breeding this dog, are you willing to obtain all necessary heath clearances
required in our puppy sales contract, including screening for hip and elbow dysplasia, thyroid,
heart and eye abnormalities? Yes______ No______
If you are purchasing a companion only puppy, are you willing to obtain all necessary health
clearances listed above so that we can maintain records of our Golden Retrievers in order to
ensure the highest breeding standards? Yes______ No______
Do you understand that our companion only puppies are sold on Limited Registration basis
which under AKC rules means your Golden Retriever is registered as purebred but ineligible for
breeding (unless lifted only by us)? Yes_____ No_____
Is there anything else that you want or expect regarding your puppy that we have not covered?
Yes____ No____
If yes, please explain:______________________________________________________
________________________________________________________________________
An adult golden retriever weighs between 55 and 80 lbs. They are an active sporting
breed and require regular exercise as well as the companionship of people. They are eager to
please and readily trainable, but training takes time, patience and consistency. Golden puppies
need to eat multiple meals a day and need frequent potty breaks. Your puppy will inevitably
make mistakes as it is learning. It may soil in the house, chew on household items or furniture,
dig in the yard, bark, shed hair and get muddy.
I/we,(print name(s)) ________________________________________________,
understand that this questionnaire constitutes the basis for a potential sale of a Golden Retriever
puppy and as such, the responses provided are complete, accurate and provide no
misrepresentations. I/we understand that this questionnaire will be maintained along with a sales

contract and may be used as evidence in a court of law in the case of breech of contract.
The agreed purchase price is ____________. A deposit of $____ (nonrefundable) shall
accompany the return of this questionnaire. Make checks payable to ________________.
Please sign both copies. Keep one for your records and mail/hand deliver one copy to:

Additional contact information:

(252) 555-1212 (preferred)
Email: _____________________
Breeder signature:____________________________________ Date:_______________
Breeder printed name:________________________________
Buyer signature:_____________________________________ Date:________________
Buyer printed name:_________________________________
Buyer signature:_____________________________________ Date:________________
Buyer printed name:_________________________________