Windy Mesa Australian Shepherds



Your Name(s):
Physical Address:
Mailing Address:
Phone 1: 
Phone 2:
Best way to contact you: 

Which of our studs do you wish to breed to?

Bitch's Call Name:
Registered Name:
Registration Number(s):
Please attach copies of registration certificates.
Please attach a copy of pedigree.
DNA Status: 

Date of Birth:
Body Color & Trim:
Eye Color: Left: 
Please send current pictures or video of your bitch.
Natural & Current Tail Length (i.e. long tail, docked):
Does she have a natural ear set?
Was she born with rear dewclaws?
Teeth: Bite:
(front, rear, topline)

Movement: (coming, going, side gait)

Type of Coat: 

Eye Exam: Date of last exam:
                 CERF or OFA#: 
                 Doctor's name, practice & location:

Hips: Results:
Brucellosis: Date of last test: 
Other Health Clearances:
(elbows, thyroid, MDR1, hereditary cataracts, etc.)

Please attach copies of her current vaccination records, most recent CERF Exam Report, OFA certificates and any other health clearance reports or certificates.

Medical History: (allergies, epilepsy, cataracts, other eye problems, thyroid problems, aggression problems, injuries, internal parasites, etc.)

Family Medical History: (sire, dam, grandparents, great-grandparents, aunts, uncles, siblings, etc.)

Temperament: (everyday, with other dogs, with strangers, etc.)

Activities & Training: (conformation, obedience, rally, herding, agility, tracking, SAR, hunting, sledding, therapy, service dog, Frisbee, flyball, etc.)

Titles Received:

Please attach copies of her title certificates.
Other Honors & Accomplishments:

Strengths: (conformationally, working ability, biddability, etc.)


Number of Litters Produced:

Was she bred naturally?
How many puppies were produced?
Any complications during whelping?

Tell us about her Offspring  (temperaments, strengths, weaknesses, faults, tail sets, health clearances, titles earned, etc.):

Tell us about her Sire & Dam:

Tell us about her Siblings:

When do you expect this breeding to take place?
What do you hope to accomplish by breeding this bitch to the chosen stud?

Describe the conditions in which this litter will be whelped and raised:

What puppy food will you feed?
Do you plan to keep a puppy from this breeding?
Do you sell your puppies on contract? (If yes, please attach a copy)
How do you choose homes for your puppies?

Do you currently have any homes lined up for this litter?

Have you read through our Stud Contract?
How long have you been breeding?
How many litters have you bred?
Have you ever bred to another breed? (i.e. bred an Australian Shepherd to a Border Collie)
Have you ever had any accidental litters? (If yes, please explain)

Have you ever sold a dog or puppy to a pet store, at auction, or to any person or firm connected with the sale or resale of dogs? (If yes, please explain)

How many dogs live with you now?
Why have you chosen to breed Australian Shepherds?

I, ______________________________________, hereby certify that the information provided in this questionnaire is true and accurate to the best of my knowledge, and that no documents or information enclosed have been falsified in any way.

Signature & Date ___________________________________________________


THANK YOU for your interest in our Studs and for completing this questionnaire!
Please copy questionnaire to an email or print and send to us by mail.

Chris & Esther Ivey   *   P.O Box 1216, Bloomfield, NM 87413   *


Back to Stud Information Page

This Web Page Created by Esther A. Ivey with PageBreezeFree HTML Editor