ENTRY FORM Details of the owner and the dog for the purpose of collecting dog semen Full name of the dog: Name of kennel: Surname of the dog semen owner: First name of dog semen owner: Full mailing address of the dog semen owner: Email address used in the reservation: Dog semen owner phone number: Date of birth of the semen owner: Dog registration number in the studbook: Dog microchip number: Date of birth of the dog: Dog breed: Dog weight: Coat color of the dog: How many times did the dog cover? How many of these matings were successful? (E.g. 5/4): When was the dog last mated and with what result? In what environment does the dog live? Describe contact with other dogs: Describe how and what the dog is fed. Vaccination (name of vaccine, date): Date of last deworming of the dog: Describe the physical load of the dog (training, walks, how often and how intensively): Describe diseases, operations and medications (even local). Indicate mainly possible gestagens, corticosteroids, cimethidine, amphotericin, nesteroids. Indicate the date of X-ray of dog´s pelvis. If the dog has previously undergone semen analysis, indicate the date and result. Describe the reason for the current semen collection. If the reason is export, indicate the destination country. HOME