Arrival Form in Lipan, TX - Champion Embryo Transfer Service

Owner Information

Name*

Address

Street Address Address Line 2 City State ZIP Code

Primary Phone*

Secondary Phone

Email*

Mare Information

Name*

Age or DOB

Breed

Color

Registration

Is the Horse Insured?

Yes
No

Insurance Co.

Telephone #

Breeding Information

Has the mare been under lights?

Yes
No

Start Date

Is the mare in foal?

Yes
No

If Yes: Last breeding date

If Yes: Last Stallion

If No

She is a Maiden and breeding has never been attempted
She was not bred the previous season.
Foal by side
Aborted pregnancy
No pregnancy has resulted

List

Foal DOB	Sire	Color	Sex

At how many months

No results after how many years and attempts?

Stallion Information

#1 Stallion

Standing at

Carry
ET
Vitrify

Phone

#2 Stallion

Standing at

Carry
ET
Vitrify

Phone

#3 Stallion

Standing at

Carry
ET
Vitrify

Phone

Preferred Care Information

Private Care
Dry Mare
Wet Mare
Foal Watch
Other
Special Instructions

If other

Instructions

Farrier Information

Trim
Front Shoes
Remove Shoes, then Trim
Needs Done ASAP
Date Last Done
Special Needs

Date

Special Needs

Medical History (Please provide the date last administered.)

Dewormer	Flu/Rhino	West Nile	Rabies	EEE/WEE/VEE/Tetanus

Rotavirus	EVA	Rhinopneumonitis (PG Mares)	Coggins

(Please bring a copy of the current coggins.)
**Mares will be given appropriate vaccinations and coggins test if they arrive without current medical history**

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Owner Information

Mare Information

Breeding Information

Stallion Information

Preferred Care Information

Farrier Information

Medical History (Please provide the date last administered.)

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