Questionnaire and Information Form

Last Name:
First Name:
Address:
City:
State:
Zip Code:
Country:
Work Phone:
Home Phone:
Email Address:
Referred By?:
Spouses' Name (if applicable):

Have you ever owned a Golden Retriever before?
Yes
No

If the answer to the previous question was no, have you ever owned a dog before?
Yes
No
Null

What Type of Dog(s) have you owned?

Do you intend to purchase a crate for your puppy and use it for training and when you are unable to monitor him/her properly?
Yes
No

Where will your puppy spend most of his/her time, and also, when he/she is an adult(i.e. backyard, in a crate, in the house,...as a bed decoration)?

Do you have a fenced-in backyard?
Yes
No

Will you be bringing your pup to your Vet every three weeks until all four sequences of shots are completed?
Yes
No

Will you be refraining from bringing your pup out in public places (especially parks) until pup is at least 4 months old and has received ALL shots?
Yes
No

If the answer to the above question is No, please give an explanation:

Do you own a pool?
Yes
No

If yes, is there a secured fence around your pool with a self-latching gate?
Yes
No
Null

If you do have a pool, what are the dimensions of space between the bars on your pool fence?

If the space is 4 inches or more, would you be willing to temporarily put up chicken wire until your pup is at least 4 months old?
Yes
No
Null

Where will your pup/dog sleep during naps and at night?

Have you already selected a Veterinarian?
Yes
No

If yes, how did you go about selecting him/her (i.e. by referral, let your fingers do the walking)?

What type of food do you anticipate you will be feeding your puppy?

Will you be feeding your puppy a high quality puppy food until he/she is at least 6 months old, before switching him/her to a high quality adult food?
Yes
No

Will you be taking your puppy to obedience classes at four months?
Yes
No

If no, please give explanation:

Were you interested in a male or female puppy (or it doesn't matter)?

What shade were you most interested in (light, medium or dark gold, or doesn't matter)?

When were you wanting to bring puppy home (spring, summer, fall, winter)?

What age of pup/adult were you interested in (new-8week, older pup, young adult, adult)?

What are your expectation of owning a golden retriever?