Submission form
This form is to collect data for the epileptic database. By submitting your dog, you agree to adding the dog and your name into the database.
NAME OF THE DOG *
Your answer
Year of birth *
Your answer
Sex *
Name of Sire *
Your answer
Name of Dam *
Your answer
Further informations as disease progression, health tests, numbers of seizures, medication etc.
Not required, but highly recommended to fill in at least basic info (when seizures started, current health status)
Your answer
Your name *
Your answer
Contact e-mail *
Required, not to be published anywhere
Your answer
Are you owner of the dog? *
If not, write here name and/or contact on the owner
Your answer
Additional info, link to pedigree etc.
Your answer
Nationality
Where the dog should be put in the database?
Your answer
Submit
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