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HEALTH QUESTIONNAIRE
TO HELP IN THE CREATION OF GENETIC PEDIGREES AND THE COMPILATION OF HEALTH HISTORY REPORT. REPORT FOR THE USE OF ALL BUA ACCREDITED UTONAGAN BREEDERS

The British Utonagan Association would like you to get involved in our current health studies, this will enable us to provide breeders with the tools required to further the future of the Utonagan, and help us work at clearing all genetic faults and will promote positive and well researched breeding programs, enabling us to keep good dogs and lines that have started producing a true type in the breeding program by breeding against defective genes that have been found in the breed. We intend to develop genetic pedigrees available to all genuine breeders in an open health registry, this is common practise in most pedigree dogs and is the best way forward to further the future of the Utonagan.

Please note that we are gathering information on defective genes, not defective dogs.

Please give us your much appreciated feedback by filling in our questionnaire and forwarding to enquiries@britishutonagan.com or by posting to :

The British Utonagan Association
(Health Questionnaire)
33 St Germaine Street
Catrine
Ayrshire
Scotland
KA5 6RG

The information gathered will be available to our breeders and genuine enquirers through BUA on a password protected area on our web site, users of the open health registry will have to sign a contract of use before a password will be allocated to them.
All Microchip numbers, DNA profiles and addresses will be withheld from the publics view for security reasons.

Thank you for your participation.

Health Questionnaire Doc.

BUA HEALTH QUESTIONNAIRE _ 2008

1 Registered name of dog: _______________________________
2 Registered name of Dam: _______________________________
3 Registered name of Sire: ________________________________
4 Date of Birth of dog: ____________________________________
5 Hip Score (N/T if unscored) ______________________________
6 Eye test (Clear/Affected) ________________________________
7 If affected what diagnosis _______________________________
8 What date was last test _________________________________
9 Elbow Score(N/T if unscored)____________________________
10 Von Willebrands test(yes/no)___________________________
11 If yes, affected/unaffected _____________________________
12 Addisons disease test(yes/no)_________________________
13 If yes, affected/unaffected _____________________________
14 Does your dog suffer Epilepsy _________________________
15 If yes, when was the first seizure_______________________
16 Was it a grand mal seizure ____________________________
17 Does your dog have any heart problems_______________________________
18 Does your dog have an undershot/overshot bite________________________
19 Has your dog suffered from Eczema __________________________________
20 What do you feed your dog _________________________________________
21 Are there any other medical problems you have encountered with your dog _
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Your Name: ………………………………........................................................................

Your Address: ……………………………….....................................................................

………………………………........................................................................

Your Tel No: ………………………………........................................................................

Thank you for your participation in our study, your help is very much appreciated

THE BRITISH UTONAGAN ASSOCIATION