SFT Fresh Chilled Extended
Canine Semen Shipment
Shipping Veterinarian: _________________________________
Clinic / Office: ________________________________________
Street Address: ______________________________________
City, State: __________________________________________
Zip Code, Country: ___________________________________
Phone: _____________________________________________
* The Society for Theriogenology recognizes effective
insemination dose may vary according to breed and size of
the stud dog but suggests a minimum effective insemination
dose of 100 million morphologically normal progressively
motile sperm for most inseminations.
Stud Dog or Semen Owner: _____________________________
Street Address: _____________________________________
City, State: _________________________________________
Zip Code, Country: ___________________________________
Phone: ____________________________________________
Registered Name of Stud: ______________________________
Stud Call Name: _____________________________________
Breed:_____________________________________________
Registration Number: _________________________________
Circle one: AKC UKC Other:_________________________
Date/results of last brucellosis test: ________________ Neg/Pos
Brucella test run: Slide agglutination/AGID/Culture/PCR/IFA
Other (specify) ________________________________________
Lab __________________ Accession # ____________________
LABEL SEMEN CONTAINER:
Stud dog owner’s name, stud dog’s name, breed,
bitch owner’s name, bitch’s name.
Semen Analysis at Collection:
Date collected/shipped: __________________________________
Number of total sperm in shipment: ________________________
% morphologically normal:________________________________
% Progressively motile: __________________________________
Motility score (1-5, 1 slowest): _____________________________
24 hour post collection test chill: _____% progressively motile
Date and route of planned insemination (Circle one)
Date(s)/Time(s) _______________________________________
Vaginal
Transcervical (TCI)
Surgical
For use of SFT Members Only
Receiving Veterinarian: _______________________________
Clinic / Office: _______________________________________
Street Address:______________________________________
City, State: _________________________________________
Zip Code, Country: ___________________________________
Phone: ____________________________________________
Semen handling instructions: (check one)
 included with this shipment.
 available on-line at: _________________________________
Registration papers: (check one)
 copy included in this shipment.
will be sent under separate cover.
Bitch Owner: ________________________________________
Street Address: ______________________________________
City, State: _________________________________________
Zip Code, Country: ____________________________________
Phone: _____________________________________________
Registered Name of Bitch: ______________________________
Bitch Call Name: _____________________________________
Breed: _____________________________________________
Registration Number: _________________________________
Circle one: AKC UKC Other:_________________________
Date/results of last brucellosis test: ________________ Neg/Pos
Brucella test run: Slide agglutination/AGID/Culture/PCR/IFA
Other (specify) ________________________________________
Lab __________________ Accession # ____________________
Semen Analysis on Receipt:
Date/time received: ______________________________________
% morphologically normal:_________________________________
% Progressively motile: __________________________________
Motility score (1-5, 1 slowest): _____________________________
*Use photographs to document the packaging and forms received
with the incoming semen shipment.
Route of Insemination completed: (circle one)
Vaginal 1 2 Date/Time ___________
Transcervical (TCI) 1 2 Date/Time____________
Surgical 1 2 Date/Time ___________
Breeding outcome: ____________________________________