about completing the form, or need help or guidance on completing any part of it, please contact the Breed Health on 01543 490849, 07787 152612, or email dalhealthsurvey18@gmail.com. ___________________________________ Q1. Please complete the table below in respect of all Dalmatians which you have owned since 01 Jan 2005. In the first column, identify the dogs as etc. These numbers are then used throughout the remainder of ‘’1’, ‘2’, ‘3’, the survey. (Space is provided for up to 10 Dalmatians, but please use a second copy of this page should you need to enter details for more). Date or Dog Code Sex Neutered? Age at Cause of Death Registered Name Year of Number (M/F) (Y/N) (if applicable) (if applicable) (optional) Birth Q2. (If neither 2A nor 2B applies, proceed to Q3) 2A Urinary Stones: please indicate with an the type of stone (if analysed), or indicate analysed’ – ‘X’ ‘not Age Dog Code Other Not Urate Struvite Xanthate When First Number (specify) analysed Diagnosed 2B Urinary Tract Infections (‘UTI’) – Number of Dog Code Age When First Separate Number Diagnosed Occurrences?
about completing the form, or need help or guidance on completing any part of it, please contact the Breed Health on 01543 490849, 07787 152612, or email dalhealthsurvey18@gmail.com. ___________________________________ Q1. Please complete the table below in respect of all Dalmatians which you have owned since 01 Jan 2005. In the first column, identify the dogs as ‘’1’, ‘2’, ‘3’, etc. These numbers are then used throughout the remainder of the survey. (Space is provided for up to 10 Dalmatians, but please use a second copy of this page should you need to enter details for more). Dog Code Number Sex (M/F) Date or Year of Birth Neutered? (Y/N) Age at (if applicable) Cause of Death (if applicable) Registered Name (optional) Q2. (If neither 2A nor 2B applies, proceed to Q3) 2A – Urinary Stones: please indicate with an ‘X’ the type of stone (if analysed), or indicate ‘not analysed’ Dog Code Number Urate Struvite Xanthate Other (specify) Not analysed Age When First Diagnosed 2B – Urinary Tract Infections (‘UTI’) Dog Code Number Age When First Diagnosed Number of Separate Occurrences?
2018%20DALMATIAN%20BREED%20HEALTH%20SURVEY.docx