Ambertru Golden Retrievers Puppy Questionnaire

Buyer Evaluation Questionnaire

This questionnaire is for the mutual benefit of you, the prospective owner, me as the seller/breeder and the Golden Retriever you plan to have as a member of your family. It does not constitute a contract on my part to provide you with a puppy, nor does it obligate you to take one. Your answers to the questions are not the only factor in the determination of your suitability as a Golden Retriever owner.

Your full name:
Address:
City, province/state, postal/zip code:
E-mail address:
Phone (including area code):
Date:

How were you referred to us? (please provide breeder or friend's name)	Internet search Breed club or other breeder Friend
How many members does your family have and what are their approximate ages? (For instance, 3 adults, two children aged 12 and 14.)
What are their occupations? Their hours of work?
Where did you hear about us? (referred? search engine?, business card?)
Is someone available throughout the day to excercise a puppy?	Yes No
Do you own your own home, rent or reside with others?	Own Rent Live with others
If you rent, has your landlord agreed in writing to allow you to have a dog on the premises?	Yes No
Is your residence rural, suburban or in the city?	Rural Suburban City
How long have you lived at your present address?
Do you have a securely fenced in yard?	Yes No
If not, how do you plan to keep your puppy from roaming/being stolen?
Do you have a pool?	Yes No
If yes, is it fenced in?	Yes No
Where will the puppy live?
Who will be the primary caregiver to the Puppy?
Does anyone in your family have allergies?	Yes No
Is there someone in your family who does not want a dog or dislikes dogs?	Yes No
Have you ever owned a Golden Retriever before?	Yes No
If yes, when? For how long?
Who did you obtain it from?
What happened to it? If deceased, how did it die?
Have you ever owned any other breeds of dog?	Yes No
If so, which breed(s) and what happened to them?
Are there any other dogs in residence in your family right now?	Yes No
If so, which breeds and what are their approximate ages?
Do you have cats?	Yes No
If yes, how many and approximately how old are they?
Do you have a regular veterinarian?	Yes No
If yes, please list name, address and phone number.
Are there likely to be any major changes in your lifestyle in the near future? (such as moving, pregnancy, care of an elderly relative etc.)	Yes No
Do you plan on using a crate for your Puppy?	Yes No
If not, why not?
Which of the following activities are you interested in pursuing?	Conformation shows Obedience Agility Pet therapy Other(Please specify)
If requesting a Show / Performance puppy please briefly summarize your experience.
Which are you primarily interested in?	Male Female
Will you accept a puppy of the opposite sex, if your first choice is not available?	Yes No
Are you willing to wait until the next available litter should a puppy not be available from the most current litter?	Yes No
What characteristics are you looking for in a Golden? (eg: size/colour/activity level)
Quite often we have a waiting list for puppies & it's unlikely that we'd have one available immediately. How long are you prepared to wait for the right puppy?
Are you prepared to have a pet/companion Golden Retriever spayed/neutered?	Yes No
If not, why not?
Are you willing to attend a minimum of one set of obedience classes?	Yes No
Are you willing to return the dog to the breeder should some unforeseen circumstance arise and you would no longer be able to keep the dog?	Yes No
Are you willing to have your Golden Retriever's hips x-rayed at 2 years of age?	Yes No
Are you willing to have your dog undergo annual eye examinations by a certified veterinary ophthalmologist?	Yes No
Are you willing to have your dog's heart auscultated by a certified veterinary cardiologist?	Yes No
Are you willing to provide the information obtained from the above tests to the breeder of your dog?	Yes No

In your own words, please describe why you want to get a Golden Retriever.

Name, address and phone number of at least two references

If you do not get a response to you application within 3 days please contact us by email. We may not have received your application.

Thank You.