Mare Reproductive Info Form

Name*

Are you an existing client of LVC?* Are you an existing client of LVC?* No Yes

Email Address*

Address*

Phone Number*

Horse Registered Name (if applicable)

Horse Barn Name*

Have we seen the horse previously?* Have we seen the horse previously?* No Yes

Age

Breed

Color

Is she a maiden mare: Is she a maiden mare: Yes No

How many foals has she carried?

Last foaling date?

Has she had difficulties associated with becoming pregnant previously? Has she had difficulties associated with becoming pregnant previously? No Yes - if yes and she was bred at a different facility, please send records to equinestaff@lodivet.com.

How many times was the mare bred?

Did she become pregnant that year? Did she become pregnant that year? Yes No

What diagnostics were performed? (culture, cytology, biopsy, antibiotic treatment, uterine lavage etc)

What were the results of the diagnostics?

Any other issues with breeding or carrying a foal?

If using for embryo transfer is she the recipient or the donor? If using for embryo transfer is she the recipient or the donor? Recipient Donor

If donor, do you also plan to have her carry a foal this year?

Has she been under lights this winter/spring? Has she been under lights this winter/spring? Yes Yes, but not 10 hours per day starting Dec 1. No

Please elaborate:

Has she received any reproductive hormones yet this year? (ex. Regumate, lutalyse) Has she received any reproductive hormones yet this year? (ex. Regumate, lutalyse) Yes No

Yes. Please list what, when, and for how long:

Are you using fresh/cooled or frozen semen: Are you using fresh/cooled or frozen semen: Fresh/cooled Frozen

If frozen, is the semen already at LVC? If frozen, is the semen already at LVC? Yes No

Stallion Name

Stallion Manager Name

Stallion Manager Phone Number