Progesterone Timing and Insemination Information Pewee Valley Veterinary CenterICSB- KentuckyProgesterone Timing and Insemination InformationOwner NamePhoneAddress Street Address City State / Province / Region ZIP / Postal Code Registered Name of BitchAKC/ or other Reg#Call NameApproximate Day of SeasonDateWhat type of breeding are you planning to do?NaturalTranscervical InseminationArtificial InseminationSurgical ImplantWill the insemination be performed at our facility?YesNoWill female/male be left at our facility for boarding?YesNoBrucellosis Results?Date tested?What type of semen is being used?Fresh (dog will be present for collection)Fresh Chilled (to be shipped to this facility)Frozen (semen stored here at ICSB-KY)Frozen (will be shipped in from another facility)Stud Call NameRegistered NameOwner of StudPhoneSemen Release Form completed?YesNoWho approvedDatePlease List ALL Current Co-Owners of Stud dog:Co-Owner Name(s)PhoneCo-Owner Name(s)PhoneI hereby authorize that all of the above information is correct to the best of my knowledge.SignatureDateCredit Card # (for fresh chilled/frozen)Expiration DateName of Card HolderCard Billing AddressZip Code
