The fields marked in red must have some data entered. All others may be regarded as optional. Your email address: Dog's Name: Sire's breed, if known: AND Dam's breed, if known: OR If parents are unknown, please describe the physical appearance of your dog: Sex: Male - neutered Female - spayed Male - intact Female - intact Approximate weight: Under 10 lbs. 10-25 lbs. 25-50 lbs. 50-75 lbs. 75-100 lbs. Over 100 lbs. Origin: Breeder Shelter Pet store Other Decade born: 1990s 1980s 1970s 1960s 1950s earlier Age at death or present age: years months (if known) What was the cause of death? (If more than one, select probable primary cause.) Still alive Accidental Addison's Bloat/Torsion Cancer Epilepsy/Other seizure condition Heart failure Immune/autoimmune related Kidney failure Liver failure Stroke Structural problem (e.g. hip dysplasia) Temperament Old Age Other (specify below) Unknown Additional comments: Thank you for participating in our survey. All information that is submitted for this study will be kept strictly confidential. Nov. 1, 1998
The fields marked in red must have some data entered. All others may be regarded as optional.
Dog's Name:
Sire's breed, if known: AND
Dam's breed, if known: OR
If parents are unknown, please describe the physical appearance of your dog:
Sex: Male - neutered Female - spayed Male - intact Female - intact Approximate weight: Under 10 lbs. 10-25 lbs. 25-50 lbs. 50-75 lbs. 75-100 lbs. Over 100 lbs.
Origin: Breeder Shelter Pet store Other Decade born: 1990s 1980s 1970s 1960s 1950s earlier
Age at death or present age: years months (if known)
What was the cause of death? (If more than one, select probable primary cause.)
Still alive Accidental Addison's Bloat/Torsion Cancer Epilepsy/Other seizure condition Heart failure Immune/autoimmune related Kidney failure Liver failure Stroke Structural problem (e.g. hip dysplasia) Temperament Old Age Other (specify below) Unknown
Additional comments:
Thank you for participating in our survey. All information that is submitted for this study will be kept strictly confidential.
Nov. 1, 1998