Ely's Fabulous Goldens

Golden Retriever Puppies located in Bellevue, Michigan                      Great Temperament, OFA, Health Clearances

Potential Puppy Owner Questionnaire

 Ely’s Fabulous Goldens

Your assistance in completing this questionnaire will help us place the right puppy with you.  While it is not our intent to be intrusive, these questions help determine whether a Golden Retriever  is the right breed for you and helps ensure a good match.  If you feel additional information would be helpful, please add additional pages as necessary.  All information is confidential.  Thank you for your interest in Ely’s Fabulous Golden Retrievers.

Name:__________________________________________________    Date:______________________


City:________________________________________    State:____________    Zip:________________

Telephone(Days):______________________________    (Evenings):__________________________

Your Occupation(s):__________________________________    E-Mail:________________________

    Full Time:______    Part Time:______

List the names and ages of all members of your household:_______________________________

What other breeds are you considering at this time?:_____________________________________

How did you first learn about the Golden Retriever?

How did you first learn of Ely’s Fabulous Goldens?

Why does the Golden Retriever appeal you?


For what purpose do you wish to purchase a Golden? (Check as many as applicable):

   Companion____    Show Dog____    Obedience____    Breeding____

Do you prefer a male_____ or female_____ puppy?  Why?________________________________

Are any members of your household allergic to dogs and/or cats?_________________________

Are there any members of your household who DO NOT want a new puppy?_______________

Is your current Residence a house_____    apartment_____    condo_____    other_____?

Do you own_____    or rent_____?

    If you rent, does your current lease permit you to have pets?_____________________

    Please give the name, address and phone number of your current landlord:______________

Does your current residence have a yard?____________

If yes, please state the general dimensions of your yard:____________________

If you have a yard, is it fully enclosed?______________

What is the height and type of fence which encloses your yard?__________________________

Where will your Golden be kept during the day?  House_____    Yard_____    Dog Run_____

   Other, please indicate:_______________________________________________________________

Where will your Golden be kept during the evenings?  House_____    Yard_____

   Dog Run_____    Other, please indicate:________________________________________________

An adult Golden requires regular exercise.  How do you intend to exercise your dog?_______

How many hours per day could you spend with your Golden on a typical weekday?_________

How many hours per day could you spend with your Golden on a typical weekend?_________

Do you have any time-consuming hobbies or interests which you feel may affect the time available to spend with your Golden?

Who in your household will be the primary caretaker(s) of your Golden?


Are any of these persons under the age of 18?___________________________________________

Do you understand that our “companion only” puppies are sold on a “limited registration” basis which under AKC rules means your Golden Retriever is registered as a purebred but ineligible for breeding?


Please list all pets you currently own:___________________________________________________

Please list the name, address and phone number of your pets’ current veterinarian:_________

Please list all of the dogs you have owned in the past ten years including the following information:

A)   Breed

B)    Where you obtained your dog(s)

C)   Sex of dog and whether it was spayed or neutered

D)   What became of the dog(s) (i.e. death, sale, gift, theft, etc.).  If by death, please state the cause of death and approximate age of dog at time of death:

Are you committed to taking care of your Golden Retriever’s  needs for its entire lifetime?_____________

Are you willing to take your Golden puppy through a formal class-oriented obedience                program?____________________________________________________________________________

Have you ever completed an AKC title on a dog in either conformation_____ or obedience_____ or other?_____

List titles completed:__________________________________________________________________

Have you ever bred a litter of puppies?_____    If yes, please state the number of times and all information pertaining to these breedings:___________________________________________

If you are considering breeding this dog, are you willing to obtain all necessary health clearances required under our puppy sales contract, including screening for hip and elbow dysplasia, thyroid and eye abnormalities?_______________________________________________

If you are purchasing a “companion only” puppy, are you still willing to obtain all necessary health clearances listed above so that we can maintain records of our Golden Retrievers in order to ensure the highest of breeding standards?______________

Please complete this form and return to:

Teresa A. Koch-Ely at email below


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