Please print out this form and take it with you along with the information your Vet will need to complete this form, such as 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 a copy or post a copy 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 be sent.  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).

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-                   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 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:  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 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 or Hospital and Name of Vet that Performed this Breeding Exam:
 

Signature of Vet: