Border Collie Collapse Questionnaire

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University of Minnesota

Email *

Owner Name *

Mailing Address

Phone

Dog's Call Name *

Breed *

Border Collie

Bearded Collie

Australian Cattle Dog

Australian Kelpie

Australian Shepherd

Collie

Shetland Sheepdog

Other:

Registered Name

Registration Number

Sex *

Male - Intact

Male - Neutered

Female - Intact

Female - Spayed

Date of Birth *

If date of birth is unknown, please approximate

YYYY

Date of Death (if applicable)

YYYY

Sire

Dam

Veterinary Clinic

Veterinary Clinic Phone

What activities does your dog routinely participate in?

Check all that apply.

Working stock

Stock dog trials

Agility

Fun Retrieves

Training Retrieves on land

Flyball

Obedience

Conformation Showing

Running alongside an ATV or bicycle

Hiking/Jogging

Guide/Service work

Other:

How would you judge your dog's body condition right now?

obese, out of shape

a little heavy, but in good shape

in perfect condition

thin

Clear selection

How would you judge your dog's temperament

excitable

normal

laid back

Clear selection

Rank your perception of your dog's aggressiveness, on a scale of 1(low or none) to 5 (high) towards the following

Other dogs

People

His/her territory

Please describe any perceived aggression or add any additional comments in the space below.

Rank your perception of your dog's intensity and desire to retrieve or herd compared to other dogs you have trained, on a scale of 1 (low or none) to 5 (high).

Rank your perception of your dog's trainability and intelligence compared to other dogs you have trained on a scale of 1(low) to 5 (high).

Compared to other dogs, does your dog seem to be more or less tolerant of high temperatures and/or humidity? *

Very tolerant, will keep exercising in hot/humid weather after other dogs might quit

Normal tolerance

Intolerant, quits exercising in hot/humid weather sooner than other dogs

Profoundly intolerant of heat/humidity

Do you use an e-collar for training?

If yes, compared to other dogs you have trained, how does your dog handle repeated correction?

Has your dog ever had a typical epileptic seizure, where he/she falls over, loses consciousness and paddles his/her legs? *

If yes, please describe these seizure(s), how often they occur and when they were first observed in your dog.

Has your dog had one or more distinct episodes of abnormal posture, gait, disorientation, or collapse that occurred during or immediately after exercise or excitement? *

If yes, please also complete the Episode portion of this questionnaire.

Yes

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