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
What is your name?
What are your dog's registered and call names?
What is your dog's gender?
What is your dog's age? (years/months)
If reporting an illness/disease please select the appropriate option(s) and describe in more detail.
Joint or bone condition
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?
What is the prognosis or outcome for the condition being reported?
If reporting an early death (before age 10) please state age and cause below.
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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