Golden Retriever Familial Subaortic Stenosis Study

 

Please complete the following form, print and include with the blood sample

Dog's Name   Click here to enter text.


Gender:   Female Spayed
   Female Intact    Male Neutered   Male Intact    
Date of birth   
Click here to enter text.


Owner Name 
Click here to enter text.


Complete Address 
Click here to enter text.


Phone Number 
Click here to enter text.


E-mail 
 Click here to enter text.


Name of cardiologist   
Click here to enter text.



Please include a copy of the pedigree and the echocardiogram report (for affected dogs) or normal cardiologist report (for unaffected dogs).

All information will remain confidential!

THANK YOU!!!