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Mare Health Form

This form must be completed and returned to Watermark Farm before requesting semen for shipment.

Mare Owner: _________________________ Phone: __________________________

Address: _____________________________ Fax: ____________________________

               ____________________________________________

Mare’s Name: ________________________________ DOB: ___________________

Breed and Registration #: ________________________Color and Markings: _______

 _____________________________________________________________________

Veterinarian: _________________________ Phone: ___________________________

Address: _____________________________ Fax: _____________________________

  _____________________________________________________________________

Foaling Mare: Due Date:_________ or Date Foaled ________ Tentative Breeding Date

                                                                                                            _____________

Non-Foaling Mare: Dates of Last Heat Cycle __________ Tentative Breeding Date

                                                                                                            _____________

Provide Dates for the Following:

Coggins Test: _________ Results: ______ Rhino Vaccine: _________ Influenza: ______

Tetanus: ________ Other: ___________________________________________________

If Positive Uterine Culture, list type and treatment: _______________________________

 ________________________________________________________________________

Deworming Schedule: ______________________________________________________

 ________________________________________________________________________

Breeding History:

Last 3 years bred _________________ Foaling Results ____________________________

Years Aborted _______________ Early Fetal Loss ______________ Caslick’s _________

Retained Placenta __________________ Other ___________________________________

Does Mare Cycle Regularly? _______________ Obvious Heat Cycles? ________________

Do you understand that the mare must be examined by ultrasound 14-18 days after insemination, by ultrasound or palpation between30-35 days and again between 50 and 60 days? __________________

The above mare is free of infection and is in sound breeding condition ___________________

                                                                                                            (Vet signature)

Mare Owner’s signature ____________________________ Date _________________