Border Terrier Breed Health Survey

Border Terrier Breed Health Group

Breed Health Survey
It is important that a separate report is given for each dog - please report on ALL of your Dogs, even if they are perfectly healthy. It is equally important to have confirmation that a Dog is healthy as well as reports of Dogs with established problems.

Forms are received by Dr. E Houston, Breed Health Co-ordinator

Once submitted you will receive a confirmation email with the details entered,

Please take a few minutes to complete this Health Survey
Dog's Details

* indicates required field
Pet Name*
Date of Birth*

DayMonthYear
Date
Sex*

MaleFemale
Colour*
Entire/ Neutered*

EntireNeutered
Dog's Kennel Club Registered Name (if known)
Kennel Club Registration Number (if known)
Sire
KC Registered Name of Sire
Dam
KC Registered Name of Dam
Q1. Is your dog vaccinated?*

RegularlyOccasionallyNever
Last Vaccination Date*

DayMonthYear
Date
Vaccine Brand*
Q2. Is your dog generally*

HealthyNot Healthy
Q3. Does your dog receive regular medication to prevent parasites(e.g. fleas and/or worms) ?*

YesNo
If you have answered Yes - then please indicate what medication and how often?
Medication*
Frequency*
Q4. Has your dog any obvious defects?*

YesNo
What type of defect?*

Teeth or MouthUndescended Testicles - oneUndescended Testicles - bothKinked TailBlindnessOther
Teeth or Mouth defect - please describe*
Please give a brief description of any defect
Q5. Have you had your dog's eyes tested recently under the BVA/KC/ISDS Eye Scheme?*

YesNo
Eye Test Details*
Please upload copy of report(s)

Browse Files

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Q6. Has your dog any chronic problem that is distressing or affects its health or welfare?*

YesNo
Please briefly describe the problem (email copy of separate sheet or papers if necessary) – If your vet has given a diagnosis please state what it is*
Veterinary Diagnosis
Is your dog on long term medication for this condition?*

YesNo
What is the treatment?*
Q7. Has your dog ever required surgery? (other than routine neutering)*

YesNo
What was the reason?*
Was the surgery successful?*

YesNoPartially
Is there any long-term treatment required?*

YesNo
Please state the treatment *
Q8. Has your dog any unusual or undesirable behaviour problems?*

YesNo
Please tick if appropriate*

AggressionTimidPoor house trainingDestructiveFits or seizuresOther
Other - Please describe*
Q9. Are there any other problems you wish to remark upon that are not covered by the questions so far?*

YesNo
If Yes then please describe*
Details of Owner
Name*

First Name (s)Last Name(s)
Address*

Street Address

Street Address Line 2

CityCounty

Postal CodeCountry
E-mail*
Phone Number

Area CodePhone Number
Enter the message as it's shown*
Please note information provided will be used for analysis by the Border Terrier Breed Health Group. We use Jotform for this form.
Should be Empty:

Border Terrier Breed Health Group

Dog's Details

Details of Owner