Puppy Purchase Questionnaire
Please copy and paste this form and email to firstname.lastname@example.org
Sire: To Be Determined_________
Date of Birth: _____TBD_________
THEME: Also to be determined___
Note: If puppy is to be owned by more than one person, for AKC registration, one person must be Owner and one must be Co-Owner.
Mailing Address, if different from above: _______________________________________________________________________
Mailing Address, if different from above: _____________________________________
Purpose: Show Companion Other: Please Explain
Where did you hear about us? __________________________________________________
Owning a dog is a large responsibility and this puppy will be part of your life for many years.
A golden takes much time for both exercise and for grooming – more than other breeds may.
Completion of this questionnaire will assist us in determining if a golden puppy will meet your requirements
as an addition to your family as well as assisting you to understand the commitment you are making to the life of this puppy.
GROOMING CONSIDERATIONS: We request you not shave your dog. Research shows the coat of a golden
retriever serves a purpose to protect the dogs skin in both summer and winter. In summer the coat protects from
sunburn, shaving the dog risks a burn that can be severe. If you have questions about this, please do not hesitate to ask.
1. What is the number of adults living in your home? _____________________________
2. What is the number of children living in your home? ____________________________
3. Is anyone in your home afraid of dogs? __ Yes __ No
If yes, please explain _____________________________________________________
4. Does anyone in your family suffer from allergies? __ Yes __ No
5. Are all members of your household away during the day? Yes __ No
If “Yes”, how many hours in an average day would the puppy be alone, and will you make arrangements
someone to come in to feed and potty the puppy?
6. Do you own or rent your home? ____ Own ____Rent
Renters must have a letter of permission from their landlord before a puppy can be taken.
7. Do you have a fenced yard? __ Yes __ No
What kind of fence? _________________________________________________________
If you do not have a fence, how will you exercise your puppy and will your puppy/adult be outside unsupervised?
8. Have you owned a dog before? __ Yes __ No
9. Do you currently have any pets? __ Yes __ No
What type and ages?_____________________________________________________
Will they adapt to adding another animal to the family?
10. Why do you want a Golden Retriever Puppy?
11. Does everyone in your household want a puppy? __Yes __No
12. Have you ever raised a puppy? __Yes __No
If yes: What Breed?_____________________________________________________
13. Are you willing to take your puppy to classes for help with training? ___Yes ___No
14. Does everyone in your house understand puppy behavior? ___Yes ___No
15. Do you agree to contact Amy Clark should it become necessary for you to place your puppy, or if you are unable to keep your puppy for whatever reason? __ Yes __No
**** Part of my (our) job(s) as reputable breeders is to be there for you to answer any questions
you may have, concerns you need addressed or assist with any training issues you may have. Also,
we request that this puppy NEVER – AND WE STRESS THIS – be placed in a humane society or
pound, kill or non-kill facility. If for ANY REASON you would need to place your puppy in another
home, we require you contact us FIRST!!! Before any re-homing would become necessary, we would
request this puppy be returned to us for placement.
16. Have you ever returned a puppy/adult dog to a breeder? ___Yes ___ No
If yes, please explain. _________________________________________________________
17. Have you put a deposit with anyone else at this time? ___Yes ___No
18. Do you understand that Goldens thrive on human attention and cannot be isolated?
This requires a huge commitment from the puppy’s “human”. ___Yes ___No
19. Are you willing to share your home with a Golden Retriever and not make him a dog who lives outside?
20. Where will your puppy sleep at night? ___Inside ___Outside
21. Do you plan on using a crate to help house train your puppy? ___Yes ___No
How do you plan on house breaking your puppy? _______________________________ ________
22. Will an adult be responsible for the feeding, grooming (Goldens shed QUITE a bit), and training of your puppy?
23. In order to help you choose the most compatible puppy, briefly tell us about your family’s lifestyle, hobbies and interests:
24. Briefly tell us about the attributes you would like your puppy/dog to possess:
25. The health of our puppies is very important to us. Are you willing to continue our efforts and follow the
recommendations which will be provided in the contract and Puppy Pack, concerning diet, supplementation,
avoiding excess weight, monitoring exercise, spay/neutering ages and minimal vaccination? ___Yes ___No
26. Are you prepared to care for your puppy for ten plus years and willing to invest in veterinary costs in the event of health problems? ___Yes ___No
27. Once puppy visits start, will you be able to visit? _____Yes _____No
28. Can your name and e-mail address be given as a puppy reference? ___Yes ___No
29. Your references (please list at least 2)
Personal Reference 1: ____________________________________________________________
Personal Reference 2:_____________________________________________________________
***NOTE: ALL PUPPIES GOING TO COMPANION/PET HOMES ARE BEING SOLD ON LIMITED REGISTRATION.
Limited registration means that your puppy is registered with AKC but no litters produced by this puppy are eligible
for registration. This is recommended by AKC and helps protect breeding programs and the health and conformation
of the individual breeds. It prevents indiscriminate breeding of dogs and the production of unwanted traits within a
breed, such as hip dysplasia and temperament disorders. If a puppy buyer later decides he/she wishes to show the puppy
at conformation events, the puppy can be re-evaluated by the breeder and if found to be show quality, the limited
registration can be arranged, breeder only, to a full registration and the sales contract can be amended to include the terms of our show contract.
RESERVATION DEPOSITS: ****NO RESERVATION DEPOSITS WILL BE TAKEN UNTIL PUPPIES ARE BORN.
(Although you can be on the waiting list now.)
If you would like to purchase a puppy from Hoosier Heartland Goldens and are willing to give one of our puppies a
forever home and treat him or her properly, with gentle, loving guidance as a treasured companion,
we ask for a $500 deposit after the birth to hold a puppy. This $500 deposit will be deducted from the full purchase
price of the puppy. Deposits are refundable until puppies are 2 weeks of age! Puppies will be held only for persons
who are approved and have made deposits.
********Thank you for taking time to complete this questionnaire********
Important: Puppies will jump on people, knock down young children, bite during teething, and can grab clothing,
therefore, should never be left loose with young children. Also, young children be rough playing with puppies even
causing serious injury. All interaction between children and puppies should be supervised. Puppies (and children)
must be taught acceptable behavior through proper training – loving and gentle training for goldens (and children)
as their hearts and spirits are giving and they react easily to praise and can be hurt by anger and critisism.