Canine Fertility Services Consent Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: 00000000000.

Address

Street Address

Street Address Line 2

TownCounty

Postcode

Dog Name

Dog Breed

Age or D.O.B

What services are being provided?

Vaginal Ovulation Cytology

Method & Purpose

A sterile vaginal swab will be taken and examined microscopically to assess the stage of the canine heat cycle. This is a non-veterinary, non-invasive procedure. No blood samples are taken.

Important Information

There are four stages to the canine heat cycle. Vaginal cytology assists in identifying the most fertile period but cannot guarantee ovulation or pregnancy. Results are valid for the date of testing only.

Consent & Acknowledgement

I consent to a non-veterinary vaginal swab being carried out on the above-named dog.
I understand that any abnormalities require referral to my veterinary surgeon at my own expense.
I understand current breeding guidelines and will contact my local council if unsure.

I understand and consent to Vaginal Ovulation Cytology

Semen Collection and Analysis

Method & Purpose

Manual semen collection will be carried out using strict hygiene procedures. A teaser bitch may be required to facilitate collection. Post-collection care will be provided to assist safe retraction. The purpose of semen collection may include evaluation, artificial insemination, semen chilling, or other reproductive procedures.

Risks & Acknowledgement

I understand the risk of paraphimosis
I accept financial responsibility for veterinary care if required
Results reflect semen quality at the time of collection only
I understand current breeding guidelines

I understand and consent to Semen Collection and Analysis

Semen Chilling and Shipping

Method & Purpose

Semen is a perishable biological material with a limited lifespan. Semen quality may deteriorate during chilling and transport.

Important Information

Semen should be assessed by the receiving clinic prior to use.

Risks and Acknowledgements

Please read carefully:

This chilled semen sample is prepared strictly for use only on the above named recipient dog for the purpose of artificial insemination.
Semen is a perishable biological material with a limited lifespan and may deteriorate during chilling and transport.
Viability should be assessed by the receiving clinic prior to use, where appropriate.
Bijoux Breeding is not responsible for courier delays, mishandling, temperature exposure, loss, or any third party involvement during transport.
No guarantee is given regarding semen viability, fertility, conception, litter size, or pregnancy outcome.
Should the sample be unsuitable or fail on arrival, neither Bijoux Breeding nor the receiving clinic shall be held liable for inconvenience, consequential loss, or financial loss.
I remain fully responsible for all veterinary, clinic, insemination, and follow up costs.

Name

First NameLast Name

Dogs Name

Dogs Breed

Dogs Age

Name

First NameLast Name

Clinic/Practice Name

Phone Number

Please enter a valid phone number.Format: 00000000000.

Email

example@example.com

Address

Street Address

Street Address Line 2

TownCounty

Postcode

I understand and consent to Semen Chilling and Shipping

Mating Assistance

Method & Risks

Mating assistance involves controlled physical assistance to facilitate natural mating between dogs.

No guarantee of pregnancy or successful conception is given. Injury, stress, or behavioural issues may occur despite appropriate handling.

Any veterinary treatment required as a result of assisted mating remains the owner's responsibility.

Important information

I understand and accept the risks involved
I understand current breeding guidelines

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: 00000000000.

Address

Street Address

Street Address Line 2

TownCounty

Postcode

Dogs Name

Dogs Breed

Dogs Age

I understand and consent to Mating Assistance

Ultrasound Scanning

Method

Ultrasound scanning is carried out using a veterinary ultrasound scanner designed for external abdominal use. The dam will be gently positioned in a standing or relaxed position. Hair may be parted or lightly clipped if required, and ultrasound gel will be applied to ensure adequate contact. The probe is placed externally on the abdominal area to visualise the uterus. No sedation, restraint, or invasive procedures are used. The scan does not constitute a veterinary diagnostic examination.

Purpose

A non-diagnostic ultrasound scan to check for pregnancy no earlier than 28 days following the last mating. If mating dates are uncertain, additional scans may be required.

Important Information

Litter size and gestational age are estimates only
Information provided is valid for the date of scan only
If I am unsure whether whelping is complete, I will seek veterinary confirmation before leaving my pet unattended
I understand current breeding guidelines

I understand and consent to Ultrasound Scanning

Microchipping

Method & Purpose

Microchipping is a permanent method of identification used to help reunite dogs with their keeper if lost or stolen and to comply with current identification requirements. A sterile microchip is implanted beneath the skin between the shoulder blades using a single-use applicator. The procedure is quick and does not require sedation. The microchip contains a unique identification number which can be scanned and recorded on an approved database. Following implantation, the microchip will be registered to the breeder. Transfer of ownership details is the responsibility of the new keeper. This procedure does not constitute veterinary treatment.

Important information:

Microchips will be registered to the breeder
Transfer of ownership details is the responsibility of the new keeper
I understand current breeding guidelines
Microchipping will be carried out in accordance with current identification and breeding guidelines.

Species of animal

Breed of animal

Number of animals

I understand and consent to Microchipping

By signing below, I confirm that I have read and understood the information relating to the fertility service(s) selected above and consent to them being carried out.

Signature