Name of Dog:

Sire:

Dam:

Gender:

Date of Birth:

Country of Birth:

Bred By:

Owned By:

Submitted By:

1.         At what age did you lose your Golden Retriever?

           0 – 2.9 Years 3 – 7.9 Years 8 – 12.9 Years 13+ Years

2.         What was the cause of death?

           Neoplasm Tumour of the Skin - Malignant Tumour of the Skin - Benign Mammary Glands Alimentary System (Digestive Tract) Lymphatic System Reproductive System Musculoskeletal Cardiovascular Neurological Trauma/Accident Old Age Unknown

3.         Most of the time your Golden Retriever was?

           In the home Kennelled Crated

4.         What was your Golden Retriever’s main diet (more than one answer is fine)?
           Use the CTRL key to select more than one.

           Dry Food Fresh Meat Can Food Vegetables Bones

5.         Which did your Golden Retriever receive on a regular basis?
           Use the CTRL key to select more than one.

           Inoculations Regular Worming Tablets Heartworm Treatment Other

6.         Did your dog ever have any adverse drug reactions?

7.         Was your Golden ever hospitalised previously?