Canine Reproduction Application Form

First and Last Name: *

Phone Number: *

Email Address: *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Pet Breed: *

What service are you interested in?

Infertility

Artificial insemination

Shipping semen

Freezing semen

Pregnancy diagnosis

Whelping questions

Why do you want to breed your dog? *

When are you wanting to breed your dog? *

Have you had experience breeding dogs before? If so, tell me more about that experience. *

Have you done screening for genetic disorders including hips, elbow, and other conditions your breed may be predisposed to? *

Are you willing to invest and commit to the process? *

What is your plan for the puppies? *

Describe the environment where you will whelp and care for the puppies. *

Do you have kids or other pets in the home? *

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