College of Veterinary Medicine

Veterinary Cardiac Genetics Lab

Doberman Pinscher Dilated Cardiomyopathy Study


Complete the following on your computer and then print using the Print Feature of your Web browser OR print first and complete the form by hand. PLEASE PRINT LEGIBLY.  

 

Dog Name
Birthdate (m/d/y)
Gender male  male-neutered 
female  female-neutered
Owner Name
Mailing Address
City
State
Zip
Phone
E-mail
Date of Last Echocardiogram:
(if ever)
Has this dog been diagnosed with dilated cardiomyopathy? Yes No
Do you know of any family history of dilated cardiomyopathy for this dog? Yes No
If yes, describe relationship of affected dogs

If possible, please include a Xerox copy of a pedigree and any echocardiogram or Holter/ECG information.

Mail the blood sample and this form to :

Veterinary Cardiac Genetics Laboratory (VCGL)
Post Office Box 605
Pullman, WA 99163-0605
 
Last Edited: Aug 13, 2009 5:52 PM   

Veterinary Cardiac Genetics Lab, PO Box 605 , Washington State University, Pullman WA 99163-0605, 509.335.6038, Contact Us   Safety Links