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Puppy/Dog Application-Profile

As a breeder, my goal is to place each of my puppies in his or her forever home. Each puppy or dog is an individual. Just as no two children in a family are identical, no two puppies are exactly alike, nor are any two prospective homes the same. During the first 10 weeks of the puppies’ lives, we will be observing and evaluating their physical traits and personality traits. We will compare my observations to the information on these questionnaires to try to determine the most appropriate home for each puppy by matching the needs of each individual dog to each prospective owner’s lifestyle. Therefore, the answers you provide in this questionnaire are vital in assisting me to match your home with the right puppy. There are no “right” or “wrong” answers. This is not a screening to eliminate a customer, but this helps us do our best to place the dog with the right energy and temperament in your home. Some of the questions may seem personal; however, candor and honesty are very important—remember, I’m trusting you for the lifetime of the dog, so correct matches are very important.

(###) ###-#### use this format please
Your Address
Street (first line) City, ST Zip (second line)
  • {name}
Which of our training programs and puppy ages are you most interested in adding to your family?
You can select as many as you are interested in
  • 10 weeks - Heritage Gold
  • 12 weeks - Heritage Silver Reserve
  • 14 weeks - Heritage Gold Reserve
  • 16-20 weeks - Heritage Diamond Reserve
  • Older puppy 6-12 Months
  • Adult dogs over a year
If you ONLY want a puppy from specific dog, provide their name below. Adding that dog's name means you ONLY want a puppy from them alone. Adding that name means you will not be eligible for other litters. (This is usually for people wanting to have their new puppy be related to a dog they already own.
Are you looking to bring home a male or female
  • Male
  • Female
  • Either
When are you ready to bring a new furry family member into your home?
Indicate below your preferred time to receive a puppy
  • I'm ready anytime!
  • I will be ready in the next 4-6mo.
  • I will be ready in the next 6-8mo.
  • I will be ready in the next 8-12mo
  • Over a year or more
I would like my puppy/dog to go into therapy, service, or emotional support work...
If you answered "yes!" to the above question, please provide more detail here


Profile of about your household
Answers A, B, and C are categorized together (pick one). Answers D ,E, and F are categorized together (pick one). Answers G and H are categorized together (pick one).
  • A.) There are no children in the home
  • B.) There are younger children in the home or around often (under 10)
  • C.) There are older children in the home or around often (ages 10+)
  • D.) This will be our/my first pup/dog!
  • E. I/we owned a dog or two
  • F.) I/we have had many dogs and pups before.
  • G.) I/we have other dogs in the home
  • H.) I/we have no other dogs in the home
Profile of Activity
Which of the three options best completes this statement about your lifestyle and activity level? "Myself or my household would be..."
  • very active
  • moderately active
  • lightly active
Profile of Household (check two most like your house)
(this is for puppy placement profile (required)
  • Very quiet
  • A little noisy at times
  • Aways busy and noisy
  • Very few if any visitors
  • Visitor some days
  • Visitor and lots of people around
Dog Lifestyle (check all that are true)
(this is for puppy placement profile (required))
  • Comes to work with me (regularly or daily)
  • Travels often
  • Has very large area to roam (acreage)
  • Has common yard space
  • Has small yard (or park to exercise)
  • Would like them to engage in sports activities
  • Would like them to swim a lot
  • Would like them to be a jogging partner (once old enough)
  • Would mostly be taking daily walks
  • Will have dog walker, or doggie day care.
  • I have a large screen for my furry friend to be a couch potato with me
  • Likes quiet time
Once your puppy is in your home and a member of your family, what will your "day-to-day" look like?


Activities you want to do with your puppy/dog...
  • swim, bike, hike, and run around a lot.
  • go most places all the time.
  • jog with me occasionally (if grown fully)
  • go on a hikes few times a month
  • some ball play in the yard
  • be fine with just leisurely walks 1-2 a day
  • brain games and enrichment activities
  • mostly snuggle watching Netflix or reading
What will your housing and outside area look like by the time your pup joins your family? Please include if the outdoor area is fenced and safe for your pup, and more.
(Ex: I live in a home with a decent size backyard, and will always supervise the puppy when outside. | I live in a home with a few fenced acres that we can play and run around in everyday | I live in an apartment, etc.)


What have your past or current experiences been like with other dogs?
  • {name}
If you are going to be working or gone during the majority of the day, what will your plan be to still provide care, attention, play time, potty breaks, and more to your puppy, while gone?


From your previous answers, we should get a good idea of what energy level you are looking for in a pup, but let us know which of the below statements sounds most ideal for your family and lifestyle.
1.) I/we are looking for a pup with plenty of energy to tag along on many adventures with us, but can mellow out inside after ample amounts of daily playtime or brain games. or 2.) I/we are looking for a pup with energy at playtime, and a pup that will tag along for leisurely walks, but will want to settle down inside. or 3.) I/we understand that our pup/dog will need exercise, playtime, and brain activities daily, but I am most looking forward to a calm pup that wants to snuggle up inside.
If your family circumstance of the primary caregiver change, who will be available to care for the puppy?
  • {name}
What traits draw your family to a Golden Retriever? 
What are you looking for in a dog?
  • {name}
Do you plan on being with the puppy during the day for care, feeding, and play, or are you able to make arrangements for someone to do so?
  • {name}
Where will the puppy be kept during the day and at night?
  • {name}
Have you ever been unable to keep or care for a dog in the past or have had any complications? If so what were the circumstances?
  • {name}
Have you ever taken a pet to a pound or shelter? If so what were the circumstances?
  • {name}
Additional Training Desired
What do you hope the energy of the puppy/dog will be like?
What attributes do you least like to see in a grown dog? (Note: We do look for traits, but this will also depend on training and home/lifestyle)
  • {name}
What are your plans to continue training?
  • {name}
Will you be attending any training classes, and at what age do you intend to start?
  • {name}
What else would you like us to know about you!? Thank you for sharing so much already and we appreciate anything else that may help us make a better more informed decision of placing the right puppy with the right family.
  • {name}
How did you hear about us?
  • {name}
1. Payment Type
You are about done! The last thing we need from you is to review the final Promises that you are making to your future furry family member.
Please check all boxes to acknowledge that you are making the below promises to your future furry family member. I WILL
  • not leave my puppy for more than 3-4 hours alone and unsupervised during the day.
  • provide daily exercise for my puppy/dog
  • provide quality nutrition, water, and regular and needed vet care.
  • provide love, care, and other needs for my puppy/dog
  • under no circumstance, I give the dog to a shelter/rescue, or similar.
From Wix Typeform 2

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