Canine DNA sample information form
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 *
Your answer
Email address *
Your answer
Phone number *
Your answer
Breed *
Pet name *
Your answer
Registered name *
Your answer
Kennel club number
Your answer
Sex *
Is your dog neutered? *
Age at neutering
Your answer
Date of birth *
MM
/
DD
/
YYYY
Sire *
Your answer
Dam *
Your answer
Any current or previous medical/health problems
Your answer
Age/date of diagnosis
Your answer
Any drugs that the dog is on NOW, how long for and dose
Please give as much information as you have
Your answer
Any drugs that the dog WAS on, how long for and dose
Please give as much information as you have
Your answer
Date of most recent heart test (if applicable)
MM
/
DD
/
YYYY
Any other information/comments
Your answer
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