Irish Wolfhound Seizure Study

Irish Wolfhound Seizure Study

Preliminary Questionnaire


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Study of Seizures in Irish Wolfhounds Questionnaire

Your name:
Your Address
Phone #
Email Address
Wolfhound's Registered Name
Call Name
Sex
Birth Date
Sire
Dam
Total Pups in Litter
Is this dog living?
Date or Age at Death
Food Brand
House or Kennel Dog?
Cause of Death
DHLP/Parvo:
Combination?
Separate?
Intervals given
Other Medications / Heartworm / Flea Control etc:


Onset of Seizures :
Age
or Date
Frequency

Occurrence:
During sleep/rest?
During the Day?
At Night ?
Type of Seizure
Neurological Exams
Other Exams/Tests
Seizure Medications
Dose
Contact DVM:
Temperament:

 

Comments / Observations:



Or you can mail the completed form to:
Anne Janis
121 Chappell Rd,
Fayetteville, GA 30215
email: iwstudies@comcast.net

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