Puppy Questionnaire                   

We appreciate your interest in one of our puppies.  This questionnaire serves two purposes:   First, it ensures that all of our puppies are placed in well-suited homes and with families who are capable and aware of the care and long-term commitment necessary in owning a Golden Retriever.

Secondly, it allows me to match you with a puppy whose personality best fits your lifestyle, level of activity, family dynamics, etc. 


City, State, Zip:

Home Phone:


Your Occupation:

Spouse’s Occupation:

Gender/Ages of Children in the Family:

Additional information about yourself/your family:

How did you learn about us?

What makes you want to purchase a Golden Retriever puppy?

Do all family members want a new puppy?

Do you prefer a Male or Female?

For what purpose(s) are you purchasing a Golden Retriever?

Have any family members ever been bitten by a dog?  (If so, please give details below)

Comments regarding bite:
Are any family members afraid of dogs?

Do you own or rent your principal residence?

Where will the Golden be accommodated during the day:

Please provide details:
Is someone home during the day to house train the puppy?

If "no", what kind of arrangements will you be making for your new puppy?

Have you ever owned a puppy?  If so, what breed?

Who will train this dog?

Have you ever crate-trained a puppy or dog?

What type of personality are you looking for in your puppy?

Please include anything else that will help us place the right puppy with you:
Do you have a fenced yard?

Do you lock your gates?

Please describe yard size and fencing:

Are you committed to care for this dog's needs for his/her lifetime?

Do you have other pets?
Please describe (breed & age)

Are you willing to take this dog to obedience classes so that he will become an enjoyable companion and an integral part of your family?  

Have you ever completed an AKC title?

If yes, please list completed titles:

Are you willing to spay/neuter this dog?
References (Please)

Please name (2) persons who we could contact for references:


Phone #



Phone #

If possible, please include one veterinary clinic who knows you:

What is the best time to contact you so that we may discuss the purchase of one of our puppies?

Other information you wish to provide:

All of our companion or pet puppies are sold with AKC Limited Registration and spay/neuter contracts.  This means that your puppy will be registered with AKC, however none of its offspring will be eligible for registration.   A dog with a Limited Registration as well as a spayed/neutered dog can compete in all AKC events except in Conformation.

* I understand that completing this questionnaire does not automatically entitle me to a dog.
I also understand that this application is just the initial step in the interview process.    *
Thank you for your interest in our puppies,

Elizabeth Cariota
Banyan Golden Retrievers

Golden Retrievers ~ Golden Puppies ~  Atlanta, Georgia
  Yes,  I understand