Is this Swedish Vallhund's living? Yes No
Age at death: or Date Of Death: // (dd/mm/yy)
Cause of death:
Was an autopsy performed to determine cause of death? Yes No
Medication(s) administered for prevention or treatment (name the brands) of parasites, and any adverse reactions:
Vaccinations your Swedish Vallhund normally
What type(s) of food does your Swedish Vallhund
Was your Swedish Vallhund ever anaesthetised/sedated? Yes No
For what procedure (s)?
What anaesthetic/sedative was used (if known)?
Did your Swedish Vallhund have any adverse
reaction to the anaesthetic/sedative?
Was your Swedish Vallhund x-rayed to evaluate hips? Yes No
Age (s) at evaluation:
Hip surgery required? Yes No How many?
If your Swedish Vallhund hips have not been x-rayed please skip to the next section.
OFA Status (check one): Normal:
OFA Prelim Status: Age:
GDC Status (check one): Unaffected:
PennHIP DI: L: R:
X-rayed to evaluate elbows? Yes No Age(s) at evaluation:Surgery required? Yes No How many?
If your Swedish Vallhund elbows have not been x-rayed please skip to the next section.
OFA Status: Normal: left
OFA Prelim status: Age:
GDC status: Unaffected: left
For the following selections, please check any that apply. Feel free to write in notes or comments. Where applicable, please indicate how the diagnosis was made, by lab test, by vet, or by yourself (lab, vet, self).
01. Vagina hyperplasia Surgery (s) required?
05. Irritable bowel syndrome
14. Hypertrophic Osteodystrophy (HOD)
28. Cerebellar Degeneration
37. Entropion Number of surgeries:
45. Ear hematomas
48. Chronic Hot Spots Cause (if known):
63. Mammary gland
Endocrine (hormone producing) system
Kidneys and Bladders
92. Cystitis (Bladder Infection) How many?
98. Portosystemic Shunt Surgery? Yes
A1. Mitral Valve Defect
R1. Kennel Cough
A7. Irregular Heats Months Between Heats:
B6. Reabsorbed litters? How many?
Number of litters:
C1. Lack Of Interest In Female
D0. Swedish Vallhund diagnosed with a condition in
which immune failure was suspected.
How would you describe your Swedish Vallhund's temperament from 0-12 months of age? (Check all that apply):
How would you describe your Swedish Vallhund temperament from 13-24 months of age? (Check all that apply):
How would you describe your Swedish Vallhund temperament after 24 months of age? (Check all that apply):
Please include any additional comments about
this Swedish Vallhund
:Does your Swedish Vallhund have any ongoing or chronic medical problem not covered on this survey? Yes No
If yes, please elaborate
Copyright © Dlarah Swedish Vallhunds Australia - All rights reserved.