Hoosier Heartland Goldens

Golden Retrievers Raised with LOVE!!!

Getting To Know You!!!

Puppy Purchase Questionnaire

Please copy and paste this form and email to denverpassion30@yahoo.com

Date:  __________________________  

Litter:  _________________________                                 

Sire:       To Be Determined_________

Dam:  __________________________                  

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.

 Owner: ________________________________________________________________

Address: _______________________________________________________________                        

Mailing Address, if different from above: _______________________________________________________________________

Telephone:         __________________________________________________________

e-mail:  ________________________________________________________________


Co-Owner:          __________________________________________________________

Address:              __________________________________________________________


Mailing Address, if different from above: _____________________________________


Telephone:         __________________________________________________________

e-mail:                  __________________________________________________________

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

If yes:

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?         

    ___Yes                ___No

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?

                                               ___Yes                                 ___No

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:_____________________________________________________________

Veterinary Reference:




  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.



 (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.