PREGNANCY STATUS REPORT

______________________________
Mare Owner


______________________________	______________________________
Mare				Registration #

I am a graduate veterinarian currently licensed to practice in this state.

I examined the mare on this date and determined that she (is) (is not) pregnant.

______________________________	______________________________
Signature			Date

_____________________________________________________________
Veterinarian’s Name, Address & Telephone Number

Instructions:
1. The mare must be examined between 55 and 65 days after insemination.
2. This report must be received by LDF Farms within 10 days of examination.
3. The results of the examination should be described on the back of this report.
4. This report is not required if a Loss of Pregnancy Report has been received.