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!!!