NGSD Health Survey

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

NGSD Health Survey

NOTE: If you own more than one Singer, please fill out a separate survey for each. All survey respondents will receive a copy of the survey results and a "Thank You" gift.

Your name & email (optional) and the State you reside in

Total number of Singers in home

Year of birth or approximate age

If Singer is deceased, at what age? Cause of death if known? Was an autopsy done?

Option 1

Clear selection

Option 1

Clear selection

Is/ was this singer ever bred?

Yes

Clear selection

If bred, at what age(s)? What was the size and health of the litter(s)?

If you have an intact female, what month does she normally go into heat?

If you have an intact female, does she ever have a 2nd heat?

Yes

Unsure

Clear selection

What do you feed your singer?

Commercial Kibble

Canned dog food

Homemade cooked

Raw diet

Refrigerated or Frozen Commercial

Other:

Do you provide your singer any dietary supplements such as vitamins, probiotics, fish oil, etc.?

Yes

Clear selection

If you provide supplements, what kinds?

Please check any of the medical issues this singer has (or had in the past)

Allergies

Arthritis

Blood/ Lymph disorders

Bone Problems

Cancer or growths

Cataracts/ Blind/ other eye problems

Diabetes

Ear problems (infections, hearing loss)

Endocrine disorders (pituitary, adrenal or other hormonal issues)

Heart problems

Immune disorder

Infection(s)

Parasites

Kidney/ Urinary Problems

Liver/ Gall Bladder

Overweight

Pancreatitis

Seizures

Skin Problems

Teeth/ Gum problems

Thyroid problems

Undescended Testicle (one)

Undescended Testicles (both)

Other (see next question)

Please provide more information about any items that you checked, such as what age it was diagnosed, what type of infections, specific problems, what allergies, and if your Singer has had *pancreatitis: how many times? Also, if there is some health issue that your Singer had that was not on the above list, please discuss that.

Option 1

Clear selection

Does your singer take any medications regularly? If yes, what are they? Any side effects from medicine?

Has your singer ever had problems with anesthesia during or after surgery/ teeth cleaning?

Yes

Never had anesthesia

Clear selection

Please check any vaccines that your Singer has had.

Parvo

Distemper

Leptospirosis

Adenovirus

Kennel Cough

Hepatitis

Rabies

At what age were first vaccines given?

At what age was first rabies given?

How often does your Singer get routine vaccinations?

Every year

Every 2 yrs.

Every 3 yrs.

Less often

Clear selection

If your Singer has had any reactions to vaccinations, please describe.

How often does your Singer receive a rabies vaccine?

Is your Singer on a flea and tick preventative? If yes, what type?

Yes

Clear selection

If yes, what type? Collar, drops, pill, etc.?

Is your Singer on heartworm prevention?

Yes

Clear selection

Has your Singer had any blood tests in the past?

Yes

Clear selection

Would you be willing to obtain copies of lab results (if possible) to send to the NGSDCS? Lab tests help us greatly in gaining better information about Singer health.

Yes

Maybe

Clear selection

If you would be willing to share lab results with us, please write your email below.

Are you willing for this researcher to clarify any information about your Singer's health? This will be kept confidential.

Yes

Maybe

Clear selection

If yes, please write your email below.

Option 1

Clear selection

Thank you for filling out this survey. Your responses will greatly help in furthering our knowledge about health issues in NGSDs and also help us to better educate Singer owners about their Singer's wellbeing.

Gratefully, Susan Hendler, RN, MSES, NGSDCS BOD, Director of Science & Research

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms