Mare Information Hopeful Farm Sport Horses

HOPEFUL FARM SPORT HORSES
4595 Mahoney Road
McFarland WI 53558
(608) 213-8925
(608) 835-1820 fax

MARE INFORMATION SHEET -
TO BE FILLED OUT WITH AND BY VETERINARIAN

MARE______________________________________________ AGE________ Reg # ____________________

OWNER__________________________________________________________________________________

Address______________________________________________________Phone_______________________

Veterinarian's Name____________________________________________Phone________________________

Date mare due to foal_______________________Date actually foaled_________________________

Maiden mare? Yes / No Proposed breeding date_______________________________

Current Uterine Culture results____________________________________________

Current Uterine Cytology results___________________________________________

Uterine biopsy results, if done (most recent date; please attach a copy of the pathology report)

_____________________________________________________________________________________

Any prior retained placenta?___________________Caslick's done?_________________________

Any prior abortion?___________________________________________________

Reason known?__________________________________________________________________________

________________________________________________________________________________

Any prior early fetal loss?_______________________________At what stage?_____________

Any past uterine infections?____________________________________________________________

Foaling difficulty or damage?____________________________________________________________

Does the mare cycle regularly?_________________________Show heat well?_____________________

Any prior or current lameness problems?_________________________________________________

Date of last negative Coggins________________________Date of rhino, flu vac.__________________

Last three years bred were___________,__________,__________.

Last three years foaled were___________,__________,__________.

Type and frequency of de-worming used______________________________________

I, the undersigned, do hereby certify that I am a currently licensed veterinarian in the State in which this mare resides, and that on this date I have examined this mare's physical and reproductive condition, and find her to be in good health, free from evidence of uterine infection, and in acceptable breeding condition to the best of my knowledge.

_______________________________ ___________________________ ______________________
Signature of Veterinarian License Date

______________________________________________________________________________________________
Street address for shipment delivery

_________________________________________________________________________________________
City State Zip

______________________________________________
Federal Express #

RETURN THIS FORM WITH THE MARE ID SHEET