Stallion Collecting/Training Info Form

Owner Name*

Email Address*

Phone*

Address*

Horse Registered Name*

Please fill out the following information if you have not previously provided it to our office: Horse Barn Name:

Date of Birth

Breed

Color

Registration Number

Registration Association Acronym(s)

What is the purpose of this visit?* What is the purpose of this visit?* Collection for fresh/cooled shipment Collection for breeding a mare on-site Collection for frozen (note, scheduling may be limited based on time of year. Off- season is preferred) Phantom training (note, phantom training is only available during the off-season of July-February)

Has he been collected previously? * Has he been collected previously? * No Yes, by LVC Yes, at another site

Collection History: (please forward records if available)

Has he previously been collected via live-cover? Has he previously been collected via live-cover? No Yes

Has he previously been collected off of a phantom? Has he previously been collected off of a phantom? No Yes

If yes, does he need a tease mare? If yes, does he need a tease mare? No Yes

What extender was used, if known?

Other information helpful to collecting him?

Any additional information, questions etc:

I would like to receive a call from one of the veterinarians to discuss collecting this stallion prior to the appointment I would like to receive a call from one of the veterinarians to discuss collecting this stallion prior to the appointment No Yes

Phone Number for Follow Up

For fresh/cooled semen, recipient information for this collection: Please include Mare Name, Owners Name and the address to send semen.

For fresh/cooled semen, recipient information for this collection: Please include Mare Name, Owners Name and the address to send semen.

For fresh/cooled semen, recipient information for this collection: Please include Mare Name, Owners Name and the address to send semen.

For Frozen Collections. Has the stallion’s semen previously been frozen?

How many doses or mares are you hoping to breed with the semen that is frozen?