Puppy Questionnaire Form

Please fill out all fields. Thank you!

Full Name:
Email address:
Daytime Phone number with area code:
Evening Phone number with area code:
Your occupation:
Your spouses occupation:
Please describe the type of housing situation you are presently living in:
If both of you work how will you take care of the puppy during the day?
If you travel what will you do with your dog?
Where will the dog be kept at night?
Ages and number of both adults and children at home?
Do you have other pets? Please list type and age:
Have you ever owned a Golden Retriever and if so what happened to him or her?
Please list any specific requirements or what you are looking for in your next dog:
Do you have a fenced yard:
Yes No
Please list two personal references and one vet reference.
Name 1 / Address / Phone / Relationship
Name 2 / Address / Phone / Relationship
Vet Reference: Address / Phone
Questions / Comments: