Fallchase Golden Retrievers
Potential Client Questionnaire


Please complete this questionnaire fully and click the submit button below.
If you feel that any additional information would be helpful, please add it to the bottom of the form.
All information is kept confidential and used only by the Breeders/Owners of the litter.
We thank you for your cooperation and interest.

Please complete the entire form below

*** Please note use the Tab button for each
question instead of your Enter button ***

 

First Name  
Last Name  
Address  
City  
State  
Zip Code  
Home Phone  
E-Mail   
Your Occupation  
Spouses Occupation  
 Web URL  

 

Please specify which litter you are interested in:  

How did you learn about us?

Why have you decided to purchase a Golden Retriever?

Do you prefer:

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

Do all family members want a new puppy?  (yes/no)

Are there children in the Family?  (yes/no)
Gender & Ages:

Do any family members have allergies to dogs?  (yes/no)

Have any family members ever been bitten by a dog?  (yes/no)
If yes, please describe below:

Are any family members afraid of large dogs?   (yes/no)
If yes, please describe below:

Do you:  your principal residence.        Do you live in a:

Where will the Golden be accommodated during the day:

If other then please describe:

Is someone home during the day, or able to get home to "potty" the puppy? (Yes/No)

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

Do you have a securely fenced yard?   (yes/no)

Do you Padlock your gates?  (yes/no)

Do you have a chain link kennel run?   (yes/no)

If yes, what is the size?

Please describe yard size and fencing:

Are there neighborhood restrictions on owning a dog?  (yes/no)

Are you committed to care for this dog's needs for his/her lifetime?  (yes/no)

Do you have other pets?  (yes/no)
If yes, please describe (breed & age)

Are you willing to take this dog to obedience classes so that he will become
an enjoyable companion and a good canine citizen?  (yes/no)

Have you ever owned a puppy?  (yes/no)
If yes, when and what breed?

Who will train this dog?


Have you ever crate trained a puppy or dog?  (yes/no)
If no, please describe why:


Have you ever completed an AKC title?   (yes/no)
If yes, please list completed titles:

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

If you ARE considering breeding this dog, are you prepared to obtain all of the following necessary 
clearances before breeding?  
OFA Hip and Elbow clearances, CERF Eye clearance, SAS Heart clearance.  (yes/no)

If not please specify why:

Are you willing to spay/neuter this dog?   (yes/no)

Please include anything else that will help us place the right puppy with you:

Reference(s)
Please name 2 person (s)  that we could contact for references.
Please include one being name of the veterinary clinic who knows you?
List name (s), phone number (s) and email (s)
  

I understand that sending this application does not automatically entitle me to a dog.
I understand that this application is just a beginning step in the interview process.

All of our companion or pet puppies are sold with AKC Limited Registration and
spay/neuter contracts.  This means that the dog is registered with AKC however none of the offspring are eligible for registration. A dog with a Limited Registration as well as a spayed or neutered dog can compete in all AKC events except in the Conformation classes (breed ring).

Please review and then submit this completed questionnaire.  We will contact you via
Email as soon as possible regarding the availability of our Fallchase puppies.

 

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