Anticipated arrival date:__________________________________

Anticipated foal at side:______________

Pedigree of Mare: please send copy of registration papers

Medical History of Mare: please attach copy of uterine culture results

Colic:__________ Frequency:_____________________________

Allergies if known:_______________________________________

Date of last vaccinations:___________________

Date of last worming:________________(required within two months)

Breeding History of Mare:
Date of last breeding:______________Foaling date:______________

Breeding problems_____________________________________________

___________________________________________________________

Foaling problems______________________________________________

___________________________________________________________

Hormones or medications given:___________________________________

___________________________________________________________

Is Mare to stay at ranch until pregnancy is confirmed ? ____________

Ultrasound can be provided at 18 days of pregnancy for an additional charge of $25.00.

Attending Veterinarian: Dr.Bill Crank D.V.M.
Office phone#304-675-1270

Feeding Instructions:
Type of grain:_______________________Amount:____________________

Hay amount:__________________________________________________

Habits of Mare:
____________________________________________________________

____________________________________________________________

Does Mare have any dangerous propensities? If yes, describe.

____________________________________________________________

Emergency Instructions:
If Owner cannot be reached: Name_________________________________

Phone#________________________________