IVP Client Form

CLIENT DETAILS
Full Name *
First NameLast Name
Billing Address *
TownCounty
Postcode
Home Number
Mobile Number *
Email *
example@example.com
FARM DETAILS
Farm Name *
Pedigree Prefix
CPH *
Farm Address (if different from above address)
Street Address Line 2
TownCounty
Postcode
ALTERNATE CONTACTS
Herdsperson / Other
Phone Number
VET DETAILS
Practice *
Vet Name
Vet Phone
Email
DONOR DETAILS
Donors you wish to collect from, please include all possible donors, there is no charge for license: (Not required for embryo implants)

	Tag Number	Name	Date of Birth	Breed
1
2
3
4
5
6
7
8
9
10

Any comments to add
COLLECTION LOCATION
Please select one of the following:
On your farmAt livery centre
Please select vaccination status / PCHS status below:
Vacinated
Accredited
BVD
IBR
Leptospirosis
Johnes
BVD
Yes
Antigen Negative
Johnes
Risk Level
Ever Tested Positive
Please select
For livery terms, please 'tick' the following to agree:
I declare that the above disease information is true and that where I have indicated the animals are vaccinated, the vaccinations are up to date. I have read and understood the terms and conditions.If your animals are not vaccinated, livery stay is at your own risk.The animals are from a BVD free holding or have been appropriately tested before movement to comply with Scotmoves BVD Eradication scheme. (any questions regarding Scotmoves, please contact us)I the owner/agent authorise the company to subject the animals to epidural anaesthetic and oocyte/embry collection / embry transfer and accept that although due care is taken such procedures carry and element of risk.I agree that Animal Breeding Europe shall not be liable for any loss, injury or death howsoever arising to any animal during residence at these premises. Animal Breding Europe agrees to take reasonable efforts to ensure safekeeping of animals under its care. The owner shall be responsible for making adequate facilities/provision in respect of any animal/semen or embryos in respect of loss, death or injury (and/or appropriate insurance) during their stay at the company premises.
Please ensure you liase with your own vet, with regards to complying with health schemes on return to your own farm.
DECLARATION
Please 'tick' the following to agree
I, the undersigned, do declare that the donor cows listed above have: *
Been resident for at least 6 months in the EUBeen present in the herd of origin, for at least 30 days, prior to collectionCome from herds which are: Officially TB free, Officially Brucellosis free, Officially EBL (Enzootic Bovine Leucosis) free (or there has been no clinical case of EBL within the past 3 years)Come from a herd or herds which, during the previous year, there has NOT been any clinical sign of IBR/IPV
I am aware and understand the following: *
AB Europe takes no responsibility for any client/breed society DNA sampling (Client to make appropriate arrangements/enquiries regarding this)
By signing you agree to Terms & Conditions and declare all information is correct to the best of your knowledge.
Clear
Should be Empty:

	Vacinated	Accredited
BVD
IBR
Leptospirosis
Johnes

CLIENT DETAILS

FARM DETAILS

ALTERNATE CONTACTS

VET DETAILS

DONOR DETAILS

COLLECTION LOCATION

DECLARATION