WildeWood Farm, Inc.

Training / Breeding / Lessons/Clinics

4855 Heardsville Rd.,

Cumming, GA 30040

Second attachment to the On Farm Breeding contract

REPRODUCTIVE HISTORY QUESTIONNAIRE

Section 1

1. Mare Name __________________________________________

2. Year of Birth __________________________________________

3. Reproductive status _____________Maiden (never been bred) ______
_____________Open/Barren
_____________Foal at side
_____________In foal
_____________If in foal, last breeding date
_____________If in foal, will mare foal at WildeWood Farm, Inc.?

  If this mare is maiden, or if this mare has been bred at WildeWood Farm, Inc. in the past two years, you do not need to complete Section 2 and should go on to Section 3.

  Section 2

4. How many foals has this mare had? _____

5. If the mare is open, when was she last bred? _____

6. Has this mare ever been treated for a uterine infection?_____

If so what type?

_____________Streptococcus
_____________E. Coli
_____________Klebsiella
_____________Pseudomonas
_____________Other

7. Has she had a uterine biopsy? _____ If so please provide copies of biopsy reports.

8. Has the mare ever conceived twins? _____

9. Has the mare ever aborted a pregnancy? _____ If so, in what month of gestation? _____

10. Has this mare ever been diagnosed as or treated as progesterone deficient? _____

11. Does this mare readily show signs of estrus (tease) when she is "in heat"? ______

12. As far as you know, does this mare display normal 21 day estrous cycles? ______

13. Where was she last bred? __________________________________________

Contact person _____________________________

Phone number _____________________________

14. Please advise us of any other pertinent information regarding your mare's reproductive history:
__________________________________________________________________________

__________________________________________________________________________

 15. Please list the last vaccination date for your mare for the following vaccinations:

Influenza ______

Encephalitis______ 

Rhinopneumonitis ______

Tetanus ______

16. When was the last date your mare was wormed? ______ Which de-worming product was used? ________

17. Which level of mare care do you want? Paddock ______ Stall ______

18. Expected arrival date at WildeWood Farm: ____________________________

Please complete this form as soon as possible and return it with your signed Stallion Service Contract. Include your $250.00 booking fee, which will be deducted from total amount owed. If you have questions or concerns please email us.