Mastiff Health and Body Size Survey

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Note: Some of the links on this page point to PDF documents, for which you will need the Adobe Acrobat Reader.

Mastiff Health and Body Size Survey

* Required Fields

Survey Password: *

Owner Information:

1) Your Name:

First:* Last: *

2) Street Address:

3) City:State:

Zip Code:

Phone Number:

4) Email Address:

Dog Information:

5) What is your dog's registered name: *

6) What is your dog's date of birth: (mm/dd/yy)

Sample Permission:

Yes, I grant Dr. Gregory Acland permission to share

my Mastiff's DNA, currently banked with Optigen,

with the Ostrander Lab.

No, I do not wish my dog's DNA sample to be shared

with the Ostrander Lab.

I do not have my Mastiff's DNA banked with Optigen.

Please mail me a blood sampling kit so that

I may participate in the Ostrander Lab study!

Additional Information:

8) Is your dog still living? *

8a) If deceased, what was the cause of death?

8b) Was your dog euthanized (put to sleep)?

8c) When (month and year) did your dog pass away?

(mm/yy)

9) Has your dog been spayed or neutered?

9a) If yes, what age were they altered?

10) What is your dog's height at the withers (inches)?

11) What is your dog's current weight (pounds)?

12) Has your dog ever been diagnosed with cancer? *

12a) If yes, what kind of cancer?

If other, please specify:

13) Has your dog developed any other health problems for which he/she has received treatment by a veterinarian (i.e. arthritis, diabetes, thyroid problems, lameness, infection, etc.)? Has your dog been diagnosed with a second cancer in addition to the one listed above?

14) Is there anything we have not asked that you feel we should know about your dog's health?

I give my consent for members of the Ostrander lab to contact my veterinarian in order to obtain health records for the dog named above. These records are to remain in the Ostrander lab and will not be published, distributed or otherwise revealed outside of the laboratory and will be used only for canine health research purposes.

a) Veterinarian's name:

b) Name of Vet clinic/hospital:

c) Veterinarian's phone number: () -

Thank you for completing our survey! In the months to come, the Ostrander Lab will also be sending out surveys for body measurements on Mastiffs.

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