New Client Request Form (Breeding)"*" indicates required fields Step 1 of 425%At this time Suffield Veterinary Hospital (SVH) has received a large number of requests for new clients. As our number one priority is to maintain quality care for our patients, we can only accept new clients when the schedule permits, which allows us to continue to meet the expectations of offering high standards of veterinary medicine. In order for our hospital to provide the best care possible, we do require all of your pet(s) previous medical records prior to scheduling an appointment. *Please note, a deposit is required when scheduling your first appointment.Please select yes to continue.* YesPlease note, responses to submissions may take up to 14 business days. If your pet is requiring immediate medical attention, we do recommend reaching out to the nearest 24-hour care facility. Please select yes to proceed with the new client submission request.Please select yes to continue.* YesThe following is a list of recommendations and requirements specific to the Suffield Veterinary Hospital Reproduction Department. Failure to follow the requirements will result in reproductive services not being scheduled.Requirements: 1. Pre-breeding exam to screen for health issues prior to breeding. 2. Bitch and stud have been examined within 12 calendar months by a licensed veterinarian and records need to be submitted to SVH prior to any appointments being scheduled if services are not performed by SVH doctors. 3. Bitch must be up to date on a heartworm/tick test (often called a SNAP or 4DX test) within 12 months of breeding and the results submitted to SVH. 4. Bitch and stud must be up to date on rabies vaccination and a copy of the rabies certificate must be submitted to SVH (receipts are not a complete record). 5. Bitch must be a minimum of 18 months (1.5 years) old for reproductive services. 6. Stud must be a minimum of 18 months (1.5 years) old for reproductive services.Recommendations: 7. Stud be up to date on heartworm/tick test within 12 months of breeding and the results submitted to SVH. 8. Brucellosis testing for bitch and stud within 30 days of breeding (minimum of once a year) with results submitted to SVH. 9. Bitch and stud be up to date on distemper vaccination, as well as Lyme/Lepto/Bordetella if the owner/breeder so chooses.Please select yes to continue.* YesToday's Date* MM slash DD slash YYYY Owner's Name* First Last Home PhoneCell PhoneDoes your cell phone allow text messages? Yes NoPrimary Contact Number Home Cell OtherEmail Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Pet InformationNameSpeciesBreed Add RemovePlease write a brief description of the services you are requesting for your pet(s)Do you have or can you obtain your pet(s) previous medical records? Yes NoIf yes, previous medical records will be sent via fax (860-668-4785) email/attachment mail drop off to our facilityMedical RecordsMax. file size: 256 MB.Please list below the names of the previous medical facilities where your pet(s) have received previous medical care. Add RemoveHow many years have you been working with your current breed?How many years have you been breeding?Do you also need or want regular health services with Suffield Veterinary Hospital? Yes NoAre you familiar with your breed health testing requirements? Yes NoHave your breeding dogs and bitches had their health clearances? Yes NoDo you feel comfortable with and understand the process of progesterone timing for breeding? Yes NoWhat are your plans for your upcoming breedings (ex fresh, chilled, or frozen semen)?Do you own both the sire and dam or do we need medical records for one or the other? Yes NoWill you need support for ultrasound, xrays, and whelping management? Yes NoAre you comfortable with nutritional management of a pregnant bitch? Yes NoAre you comfortable with, or have you whelped out litters in the past? Yes NoDo you feel your bitch will need elective c-sections? Yes NoDo you want to have emergency c-section coverage guaranteed during our operating hours? Yes NoDo you need freezing services for your stud? Yes NoNameThis field is for validation purposes and should be left unchanged.
