General Information

Country: Owner's Name (optional):

Owner ID:   Telephone (Optional): 

(the ID fields allow us to avoid duplicates, make updates and enable us to contact you in case of errors - we recommend using your e-mail address or kennel club registration number, or you can enter your own made up ID if you prefer)

Interests (tick all that apply)

Breeding   Companion    Conformation  Obedience  Agility  Tracking  Herding

Therapy    Search & Rescue   Other
 

Swedish Vallhund ID:

(this field is used to avoid duplicates and allow updates ONLY - we recommend using the Swedish Vallhunds registration number)

Swedish Vallhund's Country of birth:

Sex:  Male Female               Date Of Birth: // (dd/mm/yy)

Swedish Vallhund's  overall general health:     Excellent       Good      Fair      Poor      Bad

If health is impaired, at what age did your Swedish Vallhund's start to have significant health problems? 

Titles:
 

Has this Swedish Vallhund ever been bred?  Yes No

Mortality

Is this Swedish Vallhund's living?  Yes No

Age at death:       or Date Of Death: // (dd/mm/yy)

Cause of death:

Was an autopsy performed to determine cause of death?  Yes No

Medicines

Medication(s) administered for prevention or treatment (name the brands) of parasites, and any adverse reactions:

Adverse reactions:

Vaccinations

Vaccinations your Swedish Vallhund normally receives:
 

Diet

What type(s) of food does your Swedish Vallhund eat?
 

Homemade
Raw (Bones And Raw Food)

Do you supplement your Swedish Vallhund food?   Yes No List supplements:

Anaesthetic

Was your Swedish Vallhund ever anaesthetised/sedated?  Yes No

For what procedure (s)?

What anaesthetic/sedative was used (if known)?

Did your Swedish Vallhund have any adverse reaction to the anaesthetic/sedative?

Hips

Was your Swedish Vallhund x-rayed to evaluate hips?  Yes No    

Age (s) at evaluation:

Hip surgery required?  Yes No    How many?

If your Swedish Vallhund hips have not been x-rayed please skip to the next section.

OFA Status (check one):    Normal:   Excellent    Good    Fair    Indeterminate:  Borderline
      Dysplasia (degree of finding)  Mild    Moderate    Severe
      Findings: 

OFA Prelim Status:  Age: Normal:  Excellent    Good    Fair      Indeterminate: Borderline
      Dysplasia (degree of finding)  Mild    Moderate    Severe
      Findings: 

GDC Status (check one):    Unaffected:   Excellent    Good     Acceptable
       Affected (finding/degree arthrosis)  L    R

PennHIP DI: L: R:

Elbows

X-rayed to evaluate elbows?  Yes No     Age(s) at evaluation:

Surgery required?  Yes No    How many?

If your Swedish Vallhund elbows have not been x-rayed please skip to the next section.

OFA Status:    Normal:   left    right 
       Dysplasia (grade and finding):  L    R

OFA Prelim status:    Age: Normal:   left    right 
       Dysplasia (grade and finding):  L    R

GDC status:    Unaffected:  left right
       Affected (finding/degree arthrosis)  L    R

For the following selections, please check any that apply. Feel free to write in notes or comments. Where applicable, please indicate how the diagnosis was made, by lab test, by vet, or by yourself (lab, vet, self).

Miscellaneous

01. Vagina hyperplasia     Surgery (s) required?   Yes No
02. Uterine prolapse
03. Umbilical hernia
04. Cleft lip or palate
Miscellaneous Notes

Gastrointestinal

05. Irritable bowel syndrome
06. Intussusception
07. Bloat  
           Age:    How Often:  Died of bloat?  Yes No
           Surgery (s) required?  Yes No
08. Vomit or regurgitate more than 4-5 per year
09. Regurgitates or vomits food
           Bile only?  Yes No
10. Megaesophagus or esophageal dilatation
12. Eats faeces
13. Pica (eating non-food items)
Gastrointestinal Notes

Skeletal

14. Hypertrophic Osteodystrophy (HOD)
15. Osteochondritis Dissecans (OCD)   location:
16. Panosteitis age: months    Duration: months
16. Spondylosis age: years
17. Cruciate Ligament tears  type of surgery:  successful:
18. Patellar Luxation
19. Arthritis Location: Age at onset:
20. Spinal Myelopathy
21. Luxating Tarsus (hock)
22. Anury or lack of tail
23. Brachury or stub tail
24. Half tail
25. Crooked tail (kink)
26. Other:
      27.Were any surgeries required? Yes No    Number?
            Description
           
Skeletal Notes

Nervous System

28. Cerebellar Degeneration
29. Hepatocerebellar Degeneration
30. Meningitis (check one or more):
            Viral   Bacterial   Aseptic    Age at Diagnosis:
31. Hydrocephalus
32. Hypomyelination (tremblers)
33. Epilepsy
34. Seizures
            Controlled by meds? Yes No   Age at first seizure:
35. Fly snapping behaviour  Was a cause determined? Yes No
            Description
           
36. Other:
Nervous System Notes

Eyes

37. Entropion      Number of surgeries:
38. Ectropion      Number of surgeries:
39. Ectopic cilia
40. Cataracts     Age at diagnosis:     Type:
41. Progressive Retinal Atrophy (PRA)      Age at diagnosis:
42. Retinal Dysplasia     Type?    Folds    Geographic    Detachment
42. Persistent Pupillary Membranes (PPM)   Number of strands: 1-2 3-5 6 or more
43. Other eye problems:
44. Eye examination during the past 12 months
       Results:
Eye Notes

Ears

45. Ear hematomas
46. Chronic ear infections        Type: 
47. Other ear problems:
Ear Notes

Skin:

48. Chronic Hot Spots   Cause (if known):
49. Seborrhoea
50. Demodectic Mange
51. Sarcoptic Mange
52. Persistent Staphylococcal Infection (Pyoderma)
53. Allergies      Type:
54. Interdigital Cysts
54. Sebaceous Cysts
55. Sebaceous Adenitis
56. Pemphigus Foliaceus
57. Calcinosis Circumscripta
58. Histiocytomas
59. Systemic lupus erythematosus (SLE)
60. Alopecic Syndromes (colour dilution)
61. Uveodermatologic Syndrome
62. Other:
Skin Notes

Cancer

63. Mammary gland
64. Skin, subcutaneous tissue   Location:
65. Mouth
66. Osteosarcoma - bone
67. Leukaemia
68. Lymphoma - lymph node
69. Fibrosarcoma
70. Hemangiosarcoma - blood vessel
71. Cutaneous histiocytosis
72. Systemic histiocytosis
73. Malignant histiocytosis
74. Mastosarcoma   Location:
74. Squamous Cell Carcinoma - skin
74. Bladder
74. Kidney
74. Thyroid
75. Other
Age at diagnosis of any above
Treatment

Cancer Notes

Blood

76. Anaemia
77. Haemophilia
78. von Willebrand's Disease - How diagnosed:
79. Factor I Deficiency (Dysfibrinogenemia)
80. Selective IgM deficiency
81. Autoimmune Haemolytic Anaemia
82. Idiopathic Thrombocytopenic Purpura
83. Polyarteritis Nodosa
84. Other:
Blood Notes

Endocrine (hormone producing) system

85. Diabetes
86. Pancreatitis
87. Cushing's Disease
88. Addison's Disease
89. Pituitary disorder
90. Hypothyroidism Age: Medication:
91. Hyperthyroidism
Endocrine Notes

Kidneys and Bladders

92. Cystitis (Bladder Infection)    How many?
93. Familial Glomerulonephropathy
94. Stones     Type:    Cystine    Sturvite    Other
95. Incontinence
96. Renal dysplasia
97. Other:
Kidney Notes

Liver Problems

98. Portosystemic    Shunt Surgery?      Yes No
99. Chronic Active Hepatitis (NOT infectious)
A0. Other:
Liver Notes

Heart

A1. Mitral Valve Defect
A2. Tricuspid Valve Defect
A3. Stenosis Type:
A4. Murmurs
A5. Patent Ductus Arteriosus
A6. Other:
Heart Notes

Respiratory

R1. Kennel Cough
R2. Pneumonia
Respiratory Notes

Reproductive Problems

Females

A7. Irregular Heats         Months Between Heats:
A8. Refusal To Accept Male
A9. Failure To Conceive         How many times:
B0. Foetal Death (Before Birth)
B1. Fading Puppies
B2. Vaginal Infection
B3. Pyometra
B3. Herpes
B4. Mastitis (Bad Milk)
B4. Metritis (Uterine Infection)
B5. Difficulty Whelping
       Description
      

B6. Reabsorbed litters?     How many?
             How diagnosed?
B7. Other:

Number of litters:
 

Males

C1. Lack Of Interest In Female
C2. Impotence (Inability To Breed Willing Female)
C3. Sterility (No Sperm)
C4. Abnormal Sperm
C5. Undescended Testicle (s)
C6. Other Testicular Abnormality:
C7. Genital Infection
C8. Prostatitis
C9. Other:
Reproduction Notes

Immune System

D0. Swedish Vallhund diagnosed with a condition in which immune failure was suspected.
            What was the condition:
            How was the diagnosis made:
            At what age was the diagnosis made:
Immune System Notes

Temperament

How would you describe your Swedish Vallhund's temperament from 0-12 months of age? (Check all that apply):

How would you describe your Swedish Vallhund temperament from 13-24 months of age? (Check all that apply):

How would you describe your Swedish Vallhund temperament after 24 months of age? (Check all that apply):

Temperament Notes

Please include any additional comments about this Swedish Vallhund

:Does your Swedish Vallhund have any ongoing or chronic medical problem not covered on this survey?   Yes No

If yes, please elaborate

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