Health Update for the Transitional Cell Carcinoma Study

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Health Update for the Transitional Cell Carcinoma Study

* Required Fields

Survey Password: *

1) What is your dog's name: *

1a) Breed: *

2) What is your dog's current age: *

3) What is your name:

First: *

Last: *

4) Is your dog still living? *

4a) If deceased, what was the cause of death?

4b) At what age did your dog pass away?

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

5a) What kind of cancer?

If other, please specify:

5b) At what age was the diagnosis made?

5c) In what organ or on what part of the body

was the tumor found?

5d) How was the cancer identified?

Surgical biopsy with pathology

Needle biopsy with pathology

Needle Aspirate with cytology

Tumor removed surgically

Ultrasound

Radiograph (X-ray)

Blood work

Physical examination

Cystoscopy

Necropsy

Don't know

If other, please describe:

6) Has your dog had blood in his/her urine in the past year?

6a)If yes, please tell us how many days it lasted,

how it was treated and if the condition went

away after treatment.

7) Has your dog shown any of the following changes in urination patterns?

Check all that apply:

Accidents in the house

Asking to go outside more often than usual

Appearing to have difficulties releasing urine when trying

Other changes: please describe

7a)If you answered yes to any of these, please

tell us if you sought treatment for the problem,

how the problem was treated, and if it was

resolved after treatment.

8) 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.)?

9) Is your dog currently taking medication? *

If so, please list:

10) Is your dog on a veterinary prescribed diet, dietary supplement,

and/or exercise program? *

If yes, please describe.

11) 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 These records are to remain in the Ostrander lab and will not be published, distributed or otherwise revealed outside of the laboratory and will be used only for canine health research purposes.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: () -

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