Watermark Farm
136 Watermark Rd.
Oxford, PA 19363
Embryo Transfer Form
(to be completed by the Treating Veterinarian)
Donor Mare Name: ___________________________________
Donor Mare Owner: __________________________________
Recipient Mare Name: ________________________________
Treating Veterinarian Name: ___________________________
I, ________________________ (printed name), inseminated _________________
(Donor Mare) on _______________ at ______________ AM / PM.
I, ____________________________ (printed name), retrieved ______ embryos from the
Donor Mare __________________ on ________________.
In addition to this form, I, _________________________,(Vet Printed Name) hereby acknowledge and affirm that a phone call to the Watermark Farm will be made within 24 hours of any attempt at embryo recovery as well as a statement in writing that certifies the number of embryos recovered, implanted and/or stored in a cryogenic procedure.
Veterinarian Signature: ___________________________ Date: __________________
Vet
I, _____________________________ (printed name), transferred a SINGLE embryo
From _________________________(Donor Mare) to ___________________________
(Recipient Mare)
on ____________________ at _______________ AM / PM.
Veterinarian Signature: ___________________________ Date: __________________
Vet
I, ____________________________ (printed name), have performed all of the above
procedures on behalf of ________________________ (Donor Mare Owner).
_________ embryos were transferred to the Recipient Mare(s) listed above on
________________(date). ________ embryo(s) were processed and stored cryogenically.
Veterinarian Signature: _______________________________ Date: ____________
Printed Name: __________________________________
State & License #: _______________________________
Address: _______________________________________
_______________________________________
________________________________________
Phone Number: __________________________________
Fax: ___________________________________________