Veterinary Cardiac Genetics Lab

Golden Retriever Familial Subaortic Stenosis Study

Please complete the following form, print and include with the blood sample

Dog's Name


Gender Female Spayed
Male Neutered
Male Intact
Female Intact
Date of birth


Owner Name


Complete Address


Phone Number


E-mail


Name of cardiologist



Please include a copy of the pedigree and the echocardiogram report (for affected dogs) or normal cardiologist report (for unaffected dogs).

All information will remain confidential!

THANK YOU!!!