Histiocytic Sarcoma Questionnaire

As part of the research conducted on Histiocytic Sarcoma in the Bernese Mountain Dog by the CNRS Canine Genetics Team in Rennes (France), we ask you to complete this questionnaire for dogs participating in research. This document is to be completed every year after a medical examination, or after a serious illness.

 

Participation in research is free; all information submitted, concerning both the dog and the owner, will remain confidential.

English
OWNER
DOG
LIFE STYLE AND PREVIOUS DISEASES
If yes, please give details.
Please give details of the actual vaccines given and how often.
Significant diseases, particularly when an immunological etiology is implicated (for instance, chronic digestive disease, autoimmune disease, cutaneous hyper-sensibility, pyoderma, endocrinopathy, alimentary allergy, glomerulonephritis, reactive histiocytosis, other tumors such as cutaneous histiocytoma, any lameness etc.)
babesiosis, leishmaniasis, Lyme disease (borreliosis) ...
HIP AND ELBOW SCORES
HISTIOCYTIC SARCOMA

This dog had a family history of

 

 

The remainder of the questionnaire is to be completed if your dog is suspected or diagnosed with cancer.

We thank you for taking the time to complete this questionnaire.

The ANTAGENE team and the CNRS Canine Genetics Team