Reporting an Illness or Condition

Is the dog registered with the UK Kennel Club?

Yes
No

KC Registered Name (if KC registered) or Pet Name:

Sex:

Male
Female

Current Age:

Under 1 Year
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Over 20 Years

Colour:

Red
Black and Tan
Sesame
White

Has the dog/bitch been bred from?

Yes
No

Has the dog/bitch been neutered?

Yes
No

Age at neutering (if applicable):

What Health Condition are you reporting? Please select all that apply

Aural (Ears)
Cancers and Tumours
Cardiac (Heart)
Cerebral Vascular (Stroke)
Dental (Teeth)
Dermatologic (Skin)
Gastro-intestinal (Stomach/Digestion)
Hepatic (Liver/Pancreas)
Immune System (incl. Allergies)
Muscles, Bones, Joints
Neurologic (Nervous system, incl. Epilepsy)
Ocular (Eyes)
Reproductive
Urinary & Kidney
Other Conditions

Condition/s Name (Diagnosis):

Age when first diagnosed:

Under 1 year
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
19
Over 20 years

Further Information: