Name of Bitch:
Owner(s):

The following information is used to give us a clearer picture of your dog's history and your goals. The information will help us to make better decisions regarding the breeding under this contract. All information in this survey is considered confidential and will be used only to facilitate breeding your bitch. If this information is given to any other party, it will be with your permission. Thank you for your help. Please return this survey with 3 weeks from proposed mating.

Please answer the questions below to the best of your ability. If you do not know the answer to a question, please state that you do not know.

If your bitch has been bred before, please answer the following questions in this section. If she has NOT been bred before, please skip to section 2 on page two.

• How many times has your bitch been bred to date? Please list the full name(s) of the stud dog used:

• Was your bitch bred naturally or was fresh chilled or frozen semen used in each case?
 

• At what time in her season was she bred in the previous breedings? Were progesterone timing tests and/or vaginal smears used?
 

• Did your bitch carry each breeding to full term? If so, how many puppies did she have in each litter? How many survived to eight weeks in each case?
 
 

• Of the puppies that were placed, how many were placed in show, obedience or pet homes? (indicate S,O, or P for each litter).
 
 

• Did you keep any of the puppies from the above litters? If so, please give names, sex and current ages:
 

• Was your bitch cultured in any of the previous breedings and if so, did your bitch have nay significant bacterial results from those cultures?
 
 

• Has she had any other reproductive tract infections or problems that required treatment?
 

• Has this bitch failed to conceive in any past breedings? If so, please give dates and reasons, if known:
 

• How many times has your bitch been tested for Brucellosis prior to this breeding? Has the test ever been positive? This breeding requires the bitch to be tested AFTER she comes in season.
 

• Has your bitch ever been tested or treated for Mycoplasma? Please give details as required:
 

• Has your bitch had problems with previous litters such as retained puppies, puppies born dead, inertia, caesarian section, etc?
 

• Of the previous breedings, what would you state were the positive qualities that your bitch passed on to her puppies?
 

• What were the negative qualities that were consistent in her puppies?
 

• Have any of the puppies from the past litters been x-rayed? If so, what were the results?
 

• What, if any, were the disqualifying faults produced in your bitch's previous litters (undershot, overshot, long coats,etc)?
 

If this is the first breeding for your bitch, please answer the following questions to the best of your ability:

• Please state the number of seasons your bitch has had and when she is due to start her next season:

• Has this bitch ever been tested for reproductive tract, urinary or vaginal problems? If so, please give details:
 

Pertaining specifically to this breeding, please answer the following questions:

• What were the hip ratings (OFA) of the bitch's parents?
 

• Please list the ratings of your bitch's littermates (number of Excellent, good or fair or dysplastics):
 

• Please state what other examinations have been conducted on this bitch, and their results (heart, eye, thyroid, elbow, VWD, etc).
 

• Describe the temperament of this bitch, including behavior with strangers and other animals, and activity level:
 

• Where specifically does your bitch live (home or kennel)? Is she crate trained? Housetrained?
 

• Do you have specific homes for the puppies from this breeding and will you supply copies of the contracts that each puppy was placed with?
 

• Do you place companion puppies on spay/neuter contracts?
 

• Are you a member of any Code of Ethics Rottweiler clubs? If yes, please list:
 

• Does your bitch have any "serious faults" as described by the Rottweiler Breed standard?
 

• What is your bitches mouth color? Does she have complete detention?
 

• Do you plan to keep a puppy from this breeding?
 

• What is the single most important fault that you want to correct by using this stud dog?
 

• What particular goals do you hope to accomplish with this breeding?,
 

• Any other comments or information you wish to supply us with that will help us with this breeding?

Section 3:
1) How many dogs do you currently own (that live with you)?  All Rottweilers?
2) Where exactly do your dogs live?

3) How long have you been showing dogs?

4) How many litters have you bred? for a total of puppies? When did you have your first
litter?

5) What titles have you obtained on dogs owned by you?

What titles have been obtained on dogs bred by you?

6) Where exactly are your puppies whelped and raised?

7) Do you show your dogs yourself or do you hire a handler?
 
     If you hire a handler, who do you use? (list all)
 

     Do your dogs travel with them?

Thank you for your inquiry regarding our dogs. No breeding will be approved until this form is returned