Breeding Questionnaire Male-Sire

Home » Forms » Breeding Questionnaire Male-Sire

Breeding Questionnaire - Male-Sire

Please submit this form prior to scheduling an appointment. We will contact you within 24-48 hours.

Owners Name*
First Last
Co-Owners*
If there is not a co-owner, please enter your name.
First Last
Phone*
Email*
Pet's Name*
Pet's Registered Name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Kennel Registry & Number (if applicable)
Vaccination & Health Status
Rabies Vaccination*
Is the rabies vaccination current?
- Yes
- No or unknown
A current Rabies vaccination is required for all visits.
Vaccine Certificate
Prior to your visit, please e-mail current vaccination certificate to clientcare@npah.com or upload it below.
Date of most recent Brucellosis test if applicable
Date Format: MM slash DD slash YYYY
Date of most recent fecal test*
Date Format: MM slash DD slash YYYY
Was the fecal test negative?*
- Yes
- No
What was the fecal test positive for?*
Has your dog had any health screening completed?:*
OFA, PennHip, Other
- Yes
- No
What screening has been done?*
Has your dog been DNA tested?
- Yes
- No
Is your dog currently under any veterinary care other than preventative wellness?*
- Yes
- No
What are they under care for?*
Is your dog currently on any medications/supplements?*
- Yes
- No
Please list all medications/supplements*
Click the plus symbol to add each additional item.
What are you currently feeding your dog?*
Previous Breeding History
Has your sire been used for breeding before?*
- Yes
- No
What are your breeding goals for this sire?*
How many times has your sire been used for breeding?*
Methods used for breeding*
Choose all that apply:
- Natural
- Vaginal AI
- TCI
- Surgical
- Collection of fresh semen
- Collection of semen for freezing
- Collection of semen to be chilled & shipped
How many confirmed pregnancies?*
How many puppies per litter?*
Example: 1st litter, 3 pups etc.
Will you be bringing a teaser bitch to the collection?*
- Yes
- No
Are you consulting with any other veterinarians or persons for this breeding?*
- Yes
- No
Please elaborate
Does your dog have any stress or anxiety inside or outside of a veterinarian hospital?*
- Yes
- No
Please elaborate
Important!
Please scroll the form for missing required information (marked with an asterisk*) prior to clicking on Submit button below. Once you click Submit, you will see a message that says your form was successfully submitted. If you do not, please re-scroll the form.
Any additional information we should know or any concerns you may have:

Print this page
Email this page to a friend
Share this page on Facebook
Share this page on Twitter
Share this page on Google Plus

In this section

Boarding Express Check-in Form
Breeding Questionnaire Female-Bitch
Breeding Questionnaire Male-Sire
Client Authorization Form
Contact Us
Employment Application
Hospital Authorization Form
Make an Appointment
New Client Registration Form
Prescription Refill and Food Order Request Form

Make an Appointment

Refill a Presciption

Pet Health Articles

Please note, turn cell phone horizontally for best view of our website

Blog Posts

Let’s talk about heartworm disease!
July 12, 2023
Pet Photos with Santa December 3rd
November 17, 2022
Congratulations to Dr. Rossi! Westminster bound!
June 17, 2022

Hospital Hours

Monday	8:00am – 8:00pm
Tuesday	8:00am – 8:00pm
Wednesday	8:00am – 8:00pm
Thursday	8:00am – 8:00pm
Friday	8:00am – 8:00pm
Saturday	9:00am – 2:00pm
Sunday	Closed

We are closed the 1st and 3rd Wednesday of the month from 2-3:30 pm for our staff meeting.

Boarding Office Hours: Click Here

RSS
Facebook
Flickr

Contact
Site Map
Privacy
Admin
Staff

Breeding Questionnaire Male-Sire

Breeding Questionnaire - Male-Sire

Vaccination & Health Status

Previous Breeding History

Important!

Share

In this section

Please note, turn cell phone horizontally for best view of our website

Blog Posts