Client Intake Form - SMART Reproduction Services

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Basic Information

Farm/Ranch Name *

Owner Name *

First

Last

Phone Number *

Email Address *

Manager Name (if applicable)

First

Last

Phone Number

Email Address

ART Program Information

What techniques/technologies are you interested in applying on your operation? *

Artificial Insemination (AI)
Semen Collection and Cryopreservation
Embryo Collection, Transfer, and Cryopreservation
Ovum Pick & In Vitro Fertilization (IVF)
Shipping and Logistics
Other

Select all that apply.

If other, please explain.

What species would you like to use techniques selected in question number 1 for? *

Bovine
Caprine
Ovine
Porcine
Equine
Canine
Feline
Camelid
Exotic Species

Select all that apply.

List in detail any current ARTs or practices in use on your operation. *

If applicable, what challenges are you currently facing in the application of these ARTs? *

What goals do you want to achieve by implementing ARTs on your operation? *

What outcomes do you expect to achieve using ARTs on your operation? Fill out any applicable sections.

Current and Target pregnancy rate (%):

Current and Target birthing rate (%):

Number of embryos produced currently and in the future:

Number of recipients available currently and in the future:

Operation Overview

Primary type of operation: *

Dairy
Stocker
Feedlot
Seedstock
Commercial Grower
Government Reproduction Center
Private Reproduction Center
Other

Select all that apply.

Please specify: *

Size of Operation

Total Acres *

Grazable Acres *

Feedlot Capacity *

Location of operation (address or GPS coordinates): *

Address Line 1

Address Line 2

City

State

Zip Code

GPS Coordinates *

Years in operation: *

List all breeds present on the operation (include crossbreeds): *

Facility Details

Describe available facilities in as much detail as possible. *

Please include photos where they may be helpful.

Click or drag files to this area to upload. You can upload up to 20 files.

Select whether or not the following are available at your facility:

Reliable Electricity: *

Please describe any electrical issues you currently have. *

Filtered tap water: *

Please describe water related issues you currently have. *

Pens/Corrals: *

How many pens, barns and corrals are currently available? *

Milking parlor: *

Please describe your current milking parlor and its current production. *

Isolation/sick pens: *

How many isolation and/or sick pens are currently available?

Handling facilities (chutes, corrals, stands etc): *

Please describe chutes, corrals, stands etc you are currently using. *

Lab/Office space: *

Please describe the lab and/or office space you are currently using. *

Please list the brand, make and model of any available equipment. (e.g., AI equipment, ultrasound, semen storage tanks, etc.) *

You can add a files below, if more convenient, to support the information given.

File Upload

Click or drag a file to this area to upload.

Herd Management

Health

Please describe the vaccination protocol implemented on your operation. Include the names of drugs, when they are administered, and what they are used for: *

Please describe the measures taken to control parasites within your operation. If applicable include the names of drugs and when they are administered. *

What applicable. (copy)

Please describe any procedures or practices considered to be regular or common veterinary care at your operation. Include the names of drugs, when they are administered, and what they are used for. (e.g. hoof trimming).

Drug Name

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When to administer

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Use

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Nutrition

What is the main nutrition source for the animals? (e.g. pasture, TMR, etc.) *

Describe normal feeding practices on your operation. *

If fed hay or silage please describe the frequency of feeding, grass species, and production/storage practices. *

Describe dietary components and the percentage of the ration they make-up.

Component

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Percentage of Ration

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Are supplemental minerals made available to the animals? If yes, please include the product name and when they are available. *

Average Body Condition Score (BCS) of breeding female on an 1-9 scale. *

For more information on how to measure Body Condition Scores in farm animals : https://www.extension.purdue.edu/extmedia/as/as-550-w.pdf

List any describe any history of nutritional deficiencies if applicable. *

Are there any seasonal nutritional variations? If yes, please describe. *

What is the main water source for the animals? *

Ponds
Rivers
Wells
Springs
Other

Please describe other water sources used for animals. *

Describe any concerns related to water. *

Breeding

Is there a history of any reproductive disease within your heard? If yes, please describe. *

When is the regular calving season for your operation? If there is more than one, list both. *

Do males regularly undergo a Breeding Soundness Exam (BSE)? If yes, how often? *

Please list date of exam, outcome, and male ID for your most recent BSE if applicable.

Male ID

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Date

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Outcome

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What method(s) of breeding is currently employed in your operation? *

natural service
artificial insemination
embryo transfer

Select all that apply.

Do you do estrus detection? If yes, describe how it is performed. (e.g. using a teaser male, tail paint, estrus detection patches, etc.) *

Is there a development program in place for heifers, ewes or does? If yes, please describe. *

List the breeding goals of your operation. (e.g., genetic improvement, milk production, growth rates, etc.) *

Record Keeping

Are records being kept? *

Are the records digital or paper-based? *

Digital
Paper-based

If digital, what record-keeping system is used? *

How far back do historical records date? *

Please describe what type of animal identification tool/system is used. (e.g. ear tags, ear notching, microchips, etc.) *

Select Whether or not the following records are kept at your facility:

Matings: *

Milk Production: *

Calf, lamb, and/or kid growth (weaning weight, birth weight, etc.): *

Reproductive Performance

What is the average calving, lambing or kidding interval? (days) *

What was your conception rate for last season? (%) *

What was your calving/lambing/kidding rate for last season? (%) *

Do you cull animals that do not conceive/give birth? Explain why or why not. *

What is the age at first birth for heifers? *

If you do not have cattle type NONE.

What is the age at first lambing for ewes? *

If you do not have sheep type NONE.

What is the age at first kidding for does? *

If you do not have goats type NONE.

How many and what percentage of animals do you cull each year? *

What is the average age of your overall female herd, and recipient herd? *

Operation Management

Please list staff member's name and their qualifications (educational degree, trainings, courses, years of experience, etc). *

Do any of the staff members have experience with ARTs? If yes, please fill out the table below.

Name

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Description of Qualification/ Experience

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Do you want/need training for additional staff members? If yes, how many and in what discipline? *

Do you work closely with a veterinary provider in your area? If yes, please list the name and contact information for your preferred veterinary provider.

Name *

First

Last

Email *

Phone

Financial Information and Economics

List the funds you intend to allocate to the success of an ART program below.

Has funding (private or grant) been secured? Do you foresee any roadblocks or potential interruptions in funding due to changes in markets, government, etc.? *

Initial Setup: (in USD) *

Ongoing costs: (in USD) *

What funding sources have you applied for or secured? Check all that apply and give a brief description of any selected funding sources.

Checkboxes

internal funding

Please specify:

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loans

Please Specify

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grants

Please Specify

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other

Please Specify

How accessible are local and international markets for farm products? *

What are the main challenges experienced in accessing these markets? *

Has a Cost-Effectiveness Analysis (CEA) been performed to analyze the application of and ART program? If yes, please provide the analysis. *

Provide files to support your information, if necessary.

File Upload

Click or drag a file to this area to upload.

What is your local currency, and what are the best options for currency exchanged ? *

Are credit/debit cards widely accepted in your country, or is cash preferred? *

Soil & Forages (Supplemental Section A)

Have you ever had a soil test done? If yes, please describe any major findings and include when the analysis was performed. *

If you have not had this analysis done please type NONE.

Have you ever had a nutritional analysis done on the forages available on your operation? If yes, please describe the major findings and include when the analysis was performed. *

If you have not had this analysis done please type NONE.

Describe the predominant soil type(s) found on your operation. Please include the taxonomic classification as well if possible. *

If you have not had this analysis done please type NONE.

Do you employ any practices to maintain or improve soil health? If so please list all (e.g. reduced tillage, crop rotation plowing, rotational grazing, etc.) *

If you do not use these practices please type NONE.

Do you employ any soil conservation techniques/practices on your operation? (e.g., contour plowing, terracing) *

If you do not use these practices please type NONE.

Do your use any fertilizers or soil amendments? If yes, please list and describe the product used, quantity, and frequency of application. *

If you do not use these practices please type NONE.

List any crops grown on your operation and their use.

If you do not grow crops please type NONE in both boxes below.

Crop

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Use

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What methods do you use to control weeds and pests in your crops? *

If you do not use these practices please type NONE.

List common forages used for grazing or hay production in your pastures.

If you do not grow forages please type NONE in both boxes below.

Forage

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Use

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Do you employ any pasture improvement practices? (e.g. planting of annual forage crops, brush removal, etc.) If yes, please describe. *

What method do you use to control pests and weeds in your forage crops or pastures? *

Have you experienced any significant issues with pests or weeds in recent years? *

Give a brief description of the grazing systems used in your operation if applicable? (e.g. rotational, continuous, etc.) *

How do you determine the stocking rate and length of grazing period for pastures? *

What is your average forage yield per acre? *

Give a brief description of the management of forage harvesting and storage on your operation. Inclue what equipment is used, how and when harvest occurs, and any other relevant information. *

If you do not grow crops and/or forages please type NONE.

Legal Information (Supplemental Section B)

List and describe key agricultural policies that affect farming in your area.

Policy

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Effect

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Are there any specific regulations related to livestock farming? If yes, give a short description of the policy.

Regulation

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Effect

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List what import requirements exist for your country to import live animals, embryos or semen. *

What type of visa is required for a researcher to visit your country? *

Are there any government or private initiatives to promote technological advancements in agriculture? If yes, please list the initiative and give a short description of it.

Initiative

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Description

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Medicines

Select the medicines from the list below that you have access to:

Prostaglandin *

In-Synch
ProstaMate
Lutalyse
Lutalyse HighCon
estroPLAN
Synchsure
Estrumate
Dinoprost Tromethamine
Cloprostenol Sodium
I do not know

GnRH *

Cystorelin
Factrel
OvaCyst
Fertagyl
GONAbreed
Buserelin
Deslorelin
I do not know

Progesterone *

CIDR
PRID
Progesterone Sponge
I do not know

Progestin *

MGA
I do not know

Estradiol *

ZOOVET Estradiol Benzoate
PREGHEAT
Synchro-Mate B.
Estradiol Cypionate
I do not know

hCG *

Pregnyl
Chorulon
I do not know

FSH *

Follitropin
Pluset
I do not know

Geography & Climate (Supplemental Section C)

In which region or state is the operation located? *

What are the key geographic features of the area (e.g., mountains, plains, rivers)? *

What is the typical climate of the region (e.g., tropical, temperate, arid)? *

Are there any significant seasonal variations in weather? If yes, give a brief description. *

Language, Customs & Culture (Supplemental section D)

What is the primary language spoken in the country? *

Are there any common phrases or language tips that might be useful?

Word/Phrase

Meaning

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How is labor typically sourced and managed on farms? *

Are there any traditional farming practices unique to your country? If yes, give a brief description. *

How do cultural beliefs and practices influence farming operations? *

What is the level of technology adoption in farming practices? *

What are the key cultural norms and etiquette to be aware of? *

Are there any specific customs related to greetings, dress, or behavior? If yes, give a brief description. *

Health and Safety (Supplemental Section E)

Are there any health advisories or precautions to be aware of (e.g., malaria, dengue)? *

What healthcare facilities are available in case of emergencies? Provide the name of facilities and distance from farm. *

What are the general safety conditions in your country? *

Are there any areas to avoid due to safety concerns? *

Research Commitment (Supplemental Section F)

Are you committed to collecting and sharing data with the ILTI for a minimum of 5 years? *

Are there any potential research collaborators (e.g. universities, organizations, etc.) in your area? If yes, list contact information for the potential collaborators. *

Do you have a specific research project you would like to propose? If yes, give a brief description of the proposed project and its objectives below. *

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Would you provide housing for a small research team during their stay in your country? *

Would you provide meals for a small research team during their stay in your country? *

Would you provide a translator, if necessary, for a small research team during their stay in your country? *

Have you or your operation been associated with any recently published papers? If yes, please list the title and DOI below. *

List the contact information for the local contact(s) or organizations that would assist with logistics of travel or research coordination? Provide Name, Email and Phone number. *

Environment & Sustainability (Supplemental Section G)

Are there any specific environmental or sustainability practices you follow? If yes, list the practices and give a short description of how you employ them. *

Do you participate in any conservation programs or initiatives? If yes, list and give a short description of participation. *

If applicable, list any environmental regulations that farms in your area must comply with? *

Are there any specific sustainability initiatives promoted by the government? If yes, please list and give a short description. *

Additional Information

Upload photos to supplement your application. These photos may include (but are not limited to) livestock, facilities, hay, equipment, etc. You are very much encouraged to add photos of anything relevant to this application to help visualize your operation.

Click or drag files to this area to upload. You can upload up to 100 files.

What is the availability and quality of internet and mobile connectivity in the area? *

Are there any recommended mobile service providers or SIM cards for travelers?

How can we best communicate with you and other local partners or collaborators? *

WhatsApp
Zoom
Email
Other

If other, please explain.

List any additional comments or concerns below. *

Terms and Conditions

All customers must read and agree to the following Terms & Conditions (opens PDF in new window).

Agreement *

I have read and agree to the above Terms & Conditions.

Digital Signature (Legal Name): *

First

Last

Date: *

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