Your name
Your email address
Your vizsla's registered name
Your vizsla's date of birth
Dog or bitch Dog
Bitch
Spayed/Neutered
Yes No
If so at what age
Has your vizsla suffered from (tick all that apply)
Polymyositis
MMM (Masticatory Muscle Myositis)
Myasthenia Gravis
IBD (Inflammatory Bowel Disease)
Polyarthritis
IMHA (Immune Mediated Hemolytic Anemia)
IMTP (Immune Mediated Thrombocytopenia)
Addison's
Disease
Pemphigus
Lupus
(SLE or Discoid)
Hypothyroidism (Thyroiditis)
SLO (Symmetrical Lupoid
Onychodystrophy)
SRMA (Steroid
Responsive Meningitis-Arteritis)
Sebacious Adenitis
GI
(Gastrointestinal) problems
Allergies/Intolerance (food or skin)
Any other immune mediated illness? If so what
Age of onset of first illness
Routinely vaccinated?
Yes No
Routinely wormed eg frontline? Yes
No
Please use this box to tell us more eg any "triggers" that
you suspect
or alternatively
email us with as much information as possible
Before submitting this form please
type the security code numbers 1234 into the text box below
