*Stellar Puppy Questionaire*


*Potential Client Questionaire*

We consider each of our puppies to be precious family members, and are committed to assuring that they all become part of equally dedicated families for their entire lives. Our questionnaire is one way that we work toward this goal. Thank you in advance for taking the time to send your answers to us.

 Potential Client Questionnaire:

Please complete this questionnaire fully and e-mail back to:

Julia at


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:

First Name

Last Name




Zip Code

Home Phone


Your Occupation

Spouse's Occupation

How did you learn about us? Internet /Another breeder/ Other

Why have you decided to purchase a Golden Retriever?

Do you prefer: Male/Female/No Preference

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: Own-Rent-Lease your principal residence. Do you live
in a:  House/Townhouse/Apartment

Where will the Golden be acco
mm odated during the day:
 Crate in house
 Dog run with dog house
 Yard with dog house

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 comm
itted 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:


Please name 2 person (s) that we could contact for references (name, email, phone number).

Do you have a veterinarian that you have used and trust?  Please give the name and phone number of that clinic.

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 a Stellar  puppy.




Stellar Golden Retrievers