Our Golden Retriever Contact Form

Please answer all questions completely and truthfully .

False , ambiguous or incomplete answers will cause your application to be rejected.

Our Puppies Are Our Utmost Concern. Ask why we have no cancer or disease.

We would like all our puppies to enjoy a very long natural life. If you feel the same, please fill out this form.

What sex are you interested in?

Male Female  Either
How long are you willing to wait for a healthy puppy to be bred from one of our Dam's:
2023 Expected Breeding (Mother Nature permitting)
  I am NOT willing to plan ahead for a healthy Golden and learn what it takes to prevent cancer and disease THROUGHOUT IT'S LIFETIME from a specialized breeder in the area of Cancer and Disease Prevention

Which upcoming litter are you interested in (use up/down arrow to scroll)

<<<<-- Use this up/down arrow to choose Dam and Sire

Enter your comments or questions in the space provided below. Please keep it short and to the point.


Tell us how to get in touch with you: Please fill out completely.

Name First of Applicant             

Spouse First                                 




Applicants Last name                                                                                           

Spouse last                                 

                                                                                                      Your E-mail (Applicant)            

 Spouses e-mail                

Home Tel-Home                                                                            
Cell Phone of Spouse                                                                     

Cell Phone of Applicant                                                     

Work number 

When is the best time to contact your cell phone ?  Please be specific with the time of day.   






Street and City where your Golden will reside Full Time-- include house number 

House number and Street    


How did you find this site?                     
Are you interested in breeding or pet?   
Is this puppy for you or someone else?   
On a scale from 1 to 10 what is your interest level to own a Golden from an experienced Holistic breeder?   (10 being the highest)

On a scale from 1 to 10 what is your interest level to help AVOID Cancer (the #1 killer) throughout your puppy's lifetime and give your puppy a fighting chance to live into his/her 20's?  

(10 being the highest)

At any given time, how many hours will your Golden Retriever be alone without quality human contact EACH DAY?     Please Be Specific   (enter a number)                                                                                  

What is the total amount of hours your Golden will be alone during the each day and night?                                                                                                                  


What address will puppy live? 


What percentage of the time will your Golden be outside without HUMAN intervention?                       Enter a number for %

How many Children do you have and what are their ages and sex?  
Do you own or Rent?  

In which room of your house will your puppy/adult sleep when you go to bed?   (Be specific)   

How many years at present location?  

Have you ever personally raised a puppy in the past?       

How many years did you own him/her?  (enter a number)  

How many Dogs do you currently own?                              If none write none


  Age                                                                                                                                                                           Breed

Does your CURRENT Dog or Dogs have any health issues?     

Is he or she Neutered or Spayed?                                                     

What Brand Dog Food do you or did you feed your Dog? 


Do you use a company to spray your Lawn for weeds or ticks?


Do you like or did you ever take your dog to the Groomer or Groom your dog yourself?


Does anyone in your home have any allergies?                        
Does the primary caregiver have any disabilities, mental or physical or diseases that would interfere with him/her from caring for the puppy? If so , please explain briefly.                     

Occupation?  Husband what kind of business?       


Occupation ? Wife-What Kind Of Business?                  

Who will be the primary caregiver for your puppy?


Do you consider yourself a dog lover?            


What kind of fence do you have to contain your golden when he/she runs out the door?

           Are you interested in learning how to protect your Puppy/Adult against Allergies,
           Diseases and Cancer to extend his/her lifespan ?                 
Has your spouse read my web site before you filled out this Form?                                 yes or no


  Home Page

Copyright © 2000-2023 All rights reserved.

The information you provide will be kept on file privately by me for the sole purpose of answering questions, contacting you or reserving an upcoming puppy if qualified  and never sold or distributed to any other person or organization.