Cirneco dell'Etna Health Survey

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Welcome to the Cirneco dell'Etna Health Survey.

How to use this survey.

This is the first Health Survey conducted by the Cirneco dell'Etna Committee of the UK, in partnership with the Kennel Club Breed Health Conservation. We are urging as many Cirneci owners as possible to enter their dogs information in this survey regardless of whether you own a show, performance or pet Cirneco. Maximum participation is essential for us to get an overall health profile of the breed in the UK.

It is important to complete this survey regardless of whether your dog is fit and healthy or has/has had any health issues.

This will give us a good indication of the overall health of the breed and put any conditions identified into perspective, it will also enable us to identify any common health issues and ensure that we maintain the over all health of our Cirneci population in the UK.

All personal information given will be kept confidential and be presented anonymously.

**Please use a separate survey form for each Cirneco you have owned, living or deceased. As you complete a survey for each dog, simply restart a new survey for the next dog you are reporting on.**

Thank you for your participation

Caroline Hillyer
Breed Health Co-Ordinator for Cirneco dell'Etna Committee UK

By completing this survey you agree to give the UK Cirneco dell'Etna Breed Club and the Kennel Club permission to use the data for their breed health research. This information will not be used by any third parties.

I agree

I do not agree (if you do not agree please do not participate in the survey as your responses may be recorded)

Clear selection

Section 1 - Owner Information

How many Cirnechi currently live with you?

1 to 3

4 to 6

7 to 10

11 to 15

None

Clear selection

How many years have you owned Cirnechi?

Less than 5 years

5 to 10 years

10 to 15 years

Over 15 years

Clear selection

Are you a member of the UK Cirneco dell'Etna Club?

Yes

Clear selection

What is the dogs country of birth?

Italy/Sicily

Norway

Russia

Finland

Other:

Clear selection

Has this dog had any significant health problems?

Yes

Clear selection

Where did you obtain this Cirneco?

Directly from a breeder in the UK

Bred it myself

Directly from a breeder in another country (Imported)

Other:

Clear selection

Section 2 - Dog Information

What sex is this dog?

Female

Male

Clear selection

Is this dog neutered?

Yes

Not Applicable Female

Clear selection

Has this bitch been spayed?

Yes

Not Applicable Male

Clear selection

What is/was the overall health of this dog?

Excellent

Good

Fair

Poor

Clear selection

Is this dog still living?

Yes

If Yes please proceed to section 3

Clear selection

At what age did this dog die?

0 - 12 months

1 - 3 years

4 - 6 years

7 - 9 years

10 - 12 years

13 - 15 years

15+ years

Clear selection

What was the cause of death?

Injury

Illness

Old age

Clear selection

If the cause of death was "illness", what was the illness, how old was the dog at diagnosis and how long did this dog live after diagnosis?

**If this dog is no longer with us please submit your survey now.**

The submit button is at the bottom of the form.

Section 3 - Follow up dog information

Did this bitch have heat cycle before spaying?

Yes

Not Applicable (male/not spayed)

Clear selection

Has this dog had an adverse reaction to a vaccine?

Yes

Clear selection

Has this dog had an adverse reaction to flea/tick prevention

Yes

Clear selection

What is the current age of this dog?

0 - 6 months

6 - 12 months

1 - 3 years

4 - 6 years

7 - 9 years

10 - 12 years

12 years +

Clear selection

At what age did this dog begin to have significant health issues:

0 - 6 months

Between 6 months and 2 years

From 2 to 5 years

From 6 to 10 years

Over 10 years

Never

Clear selection

Section 4 - Has your dog been diagnosed with any of the following health issues?

Cancer or Tumors?

Yes

Clear selection