This is the same form we used to send as a PDF — you can now complete it here. Keep us informed of ovulation timing results as they come in, so we have as much flexibility as possible when scheduling the stud dog collection.

Date *

Stud dog

Call name *

Breed *

Registered name

Registration number

Date of last negative brucellosis test

Required before collection. If the test is not yet done, tell us in the notes.

Owner of stud dog *

Owner phone number *

Bitch

Call name *

Breed *

Registered name

Registration number

Owner name *

Owner address *

Owner phone number *

Owner email *

Semen shipment destination

Where the shipment is going — the receiving clinic, not your home address, unless your veterinarian has told you otherwise.

Clinic name *

Address line 1 *

Address line 2

Phone number *

Fax number

Type of insemination planned

Tick all that apply.

Vaginal AITranscervical AISurgical AI

FedEx delivery requested

Service *

Please be advised that the above options and delivery times are determined by FedEx and may vary depending on location. Furthermore, Pathways Animal Hospital cannot be responsible for any delays in FedEx shipping or delivery.

Anything else we should know

Authorization

I, the undersigned owner or representative of bitch named above, hereby agree to the above requested shipping details and limitations of liability. I agree to provide credit card payment by phone for services requested by me and rendered by Pathways Animal Hospital, unless I have made other payment arrangements. My signature below is my authorization of services and payment.

I have read and agree to the above. *

Name *

Signature *

Sign above using your mouse, finger or stylus

Chilled Semen Shipment Request

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