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Full Name*

Address Line 1*

Home Phone*

Cell Phone

Fax

Email*

Name of Bitch*

Breed*

What litter is this for her?*

Has she had prior problems whelping if she has had prior litters?*

Breeding Dates:(please also include progesterone levels for breeding and Breeding dates and ultrasound results)

Are you planning to do an ultrasound, or if you have already done one how many puppies did they see?*

How does the internet get to the location of the whelping? Cable or Satelite? Do you have a landline?

What dog food or diet are you feeding?

Are you using any suppliments?

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