Canine DNA sample information form

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Please fill in this form regularly (6-12 months, or if your dogs health changes) if your dog has had a DNA sample taken (either mouth swab or blood sample) by scientists from the University of Nottingham Vet School - if any information is unknown because your dog is a rescue please indicate this in the relevant sections.

Owner name *

Email address *

Phone number *

Breed *

Irish Wolfhound

Deerhound

Rottweiler

Other:

Pet name *

Registered name *

Kennel club number

Sex *

Male

Female

Is your dog neutered? *

Yes

Age at neutering

Date of birth *

YYYY

Sire *

Dam *

Any current or previous medical/health problems

Age/date of diagnosis

Any drugs that the dog is on NOW, how long for and dose

Please give as much information as you have

Any drugs that the dog WAS on, how long for and dose

Please give as much information as you have

Date of most recent heart test (if applicable)

YYYY

Any other information/comments

Submit

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