NEMDA Health Reporting Form
Use this form to report health issues with you dog(s) as they arise. Please e-mail copies of any vet reports to
Email address *
What is your name? *
Your answer
What are your dog's registered and call names? *
Your answer
What is your dog's gender?
What is your dog's age? (years/months)
Your answer
If reporting an illness/disease please select the appropriate option(s) and describe in more detail.
If reporting an injury select the appropriate option(s) below.
What treatment option(s) did you or are you undertaking to deal with the condition being reported?
Your answer
What is the prognosis or outcome for the condition being reported?
Your answer
If reporting an early death (before age 10) please state age and cause below.
Your answer
A copy of your responses will be emailed to the address you provided.
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