Please print out this form below or download it and bring it along with the other information your Vet will need to complete this form, such as the Pedigree, Tattoo or Microchip numbers and the Mudi Breed Standard from the AMA Mudi Standard webpage. Your Vet may require a fee for this service. The AMA will not reimburse any Vet fees for completion of this form, it is the responsibility of the owner to pay the Vet any fee owed for this service. It is recommended to take the dog for this exam when the dog has the best fur and physical condition and is an adult.
Upon completion of this exam and form, please email or send a copy via post, to the AMA and include pictures of all 4 (left, right, front, back) sides of the dog. If the copy is not legible, the AMA may require the original to be sent. If necessary, the AMA will determine via a breed judge in Hungary, if the dog examined has any disqualifying faults that would prevent it from passing this exam (as indicated in the AMA Mudi Breed Standard Disqualifications section). You will be notified of the results via email or regular post (your choice).
Veterinary Certificate for the American Mudi Association
Gold Star Award Program
Date of Exam:
Name of Dog:
Registration Number:
Registering Kennel Organization:
Tattoo # and/or Microchip ID #:
Name of Owner:
Address of Owner:
Telephone # of Owner:
Breed of Dog:
Age of Dog:
Sex of Dog: Male Female
If Male Dog, Number of Descended Testicles: 0 1 2
Height of Dog at Withers: Inches- or Centimeters-
Dew Claws on Rear Legs: No Yes, describe
Color
Color of Dog (on pedigree and on actual dog):
Multiple Colors on Dog: No Yes, describe:
White Spots or Patches, Location and Size: No Yes, describe:
Pigment Color on Nose: Black Brown Gray Liver Pink/Flesh Spotted
Pigment Color of Lips:
Pigment Color of Eye Rims:
For Merle Pattern Dogs
In Merle Pattern Dogs, is black mixed with white hairs only (or) if brown merle, brown mixed with white hairs only: Yes No, describe:
In Merle pattern dogs, is there more than two hair colors on the dog, please list them:
Head
Shape of Head is Wedge from top and side: Yes No, describe
Ear Set: High Mid-High Low
Long Fur on the Outer Edges of the Ears: Yes No
Eyes
Color of Dog's Eyes: Light Brown / Medium Brown / Dark Brown Yellow
Other Eye Color than Brown or Yellow, describe:
In Merle Pattern Dogs, is either eye merled: No Yes: Left Right
Teeth
Dentition: Complete/Full Teeth missing, describe
Scissors Bite: Yes No
Undershot or Overshot Bite: No Yes, describe
Condition of Teeth: Good Tartar Worn Broken, describe
Ears
Both Ears: Pricked Semi-Pricked Hanging Rounded Tips
Coat
Fur Type on Body Trunk: Curly Wavy Straight Other, describe
Length of Hair on Body: Long(more than 3") Medium(2-3") Short(1" or less)
Homogenous Fur on Body: Yes No, describe
Long Hair on Face and/or Front of Legs: No Yes, describe
Long Hair (Feathering) on Backs of Legs, Tail and Outer Ear Edges: Yes No
Tail
Tail Length: Docked or Natural Bob Half Tail Full Tail
Carriage of Tail, when moving at a trot:
Between Legs Horizontal Sickle over Back Tight Curl on Back
Body Structure
Deformities or Missing Body Parts: No Yes, describe
Any Apparent Limping or Movement Problems: No Yes, describe
Well Muscled: Yes No
Bone Content to Size and Shape of Dog: Light Medium Heavy
General
Temperament: Good Very Shy Aggressive
Healthy Dog Presented: Yes No
Do you have any knowledge of surgery or injury to this dog: No Yes, describe
Did you perform any health tests on this dog such as hip or elbow x- rays or eye exam: No Yes, describe
Do you know the results of any health tests performed on this dog: No Yes, list scores
Is it your opinion of this dog at this exam, that this dog is generally a good breeding specimen: Yes No, describe
Name, Address and Phone Number of Clinic/Hospital and
Name of Vet that Performed this Breeding Exam:
Date:
Signature of Vet: