APLSA Health Survey
Thank you for taking the time to fill out this APLSA Health Survey about your PON(s) or any PON(s) that have passed that you have owned or breed. APLSA is collecting information that will go into a database to help us better understand the various conditions affecting our breed. The information you provide will compliment our genetic study to find ways to promote the longevity and integrity of the breed. *All information about both you and your PON specifically will be kept confidential by APLSA.* Please enter as much information as is possible, but if not available simply say *Unknown*, or where applicable *NA*. Please fill out a *separate survey for each PON* you own, have owned, or breed and be as specific (detailed) as you can. Thank you.

*Type your answers on the lines provided*

Registered name
Call name
Sex
Spayed or neutered
Date of Spay or neuter
MM
/
DD
/
YYYY
The age of my dog is currently
Date of Birth
MM
/
DD
/
YYYY
Chronic illnesses or condition
Date of passing
MM
/
DD
/
YYYY
Age at passing
Cause of death (be as specific as possible)
Any additional information about health or behavioral problems
_____________________________________________________
Kennel of origin
Registration Organization
Registration #
OFA CHIC #
Owner's name or names
Country you live in
Mailing address
Email address
Have you completed this survey before for the same dog?
Any Genetic test results ( PRA / MDR1 / etc )
Upload Pedigree
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Additional Terms