Health Adverse Event Incident Reporting Form
| The purpose of this
incident report is to help
keep other Samoyed owners informed
of possible health problems and help the Foundation seek and select
researchers to
find causes, or solutions to health problems that effect Samoyeds. |
| NOTE: Before using
this form, you must have already created a record for your Samoyed in
the main database. If you have not already done so for this dog,
click on the "Add Samoyed"
button to add your Samoyed to the main database. In the main
database you will assign an "Identification
Number" to your
Samoyed. Once you have
completed the main database and "added"
the record, you will use that same "Identification
Number"
to complete the "Health
Adverse Event Incident Reporting Form" on this Samoyed. |
|
The data you supply on this form will be automatically entered into the secure DNA Bank database. The information you provide will be reported by the DNA Bank to a researcher or the Foundation, as anonymous statistical information. In some cases, additional follow up information on your dog's condition may be important for a scientific evaluation of the underlying cause of your Samoyed's health incident. If you wish to be contacted for further information on your dog's incident, you MUST give PRIOR CONSENT to do so by filling out the consent form on the Member Home page. |
| Return to Members Home Page |