Any information submitted will be treated in confidence and will only be used to benefit the future of the breed

Please submit a separate form for each dog.

 

Dog`s Registered Name:
Dog`s Pet Name:
Sex:	Male Female
Date Of Birth:
Registrataion Number:
Microchip Number:
BVA Hip Score:(Please send a photocopy of the test certificate)
BVA Eye Test: PRA/CEA clear? (Please send a photocopy of the test certificate)	Yes No Not Tested
Is you NI in general good health?	Yes No
If NO, please Give Details:
If you Answered No to previous question, have you advised your Dog`s Breeder?	Yes No
Males: Has your Dog got two descended testicles?	Yes No
If YES, by what age was he entire?
Neutered?	Yes No
Females: Has your Bitch had her first season?	Yes No
If YES, at what age?
Spayed?	Yes No
If your Dog is Spayed / Neutered, please give reason:
Has you NI ever suffered from joint problems?	Yes No
If Yes, what was the Veterinary diagnosis?
Has the problem been resolved?	Yes No
If still ongoing, please give details:
Has you NI ever suffered from digestive problems?	Yes No
If YES, please give details:
Has the problem been resolved?	Yes No
What action was taken to resolve problem?
What Food do you usually feed your NI?
Does your NI have an intolerance to certain foods?	Yes No
If YES, please give details:
Has your NI, ever had a bad reaction to wormer?	Yes No
What wormer was used?
If YES, what happened?
Has your NI, ever had a bad reaction to vaccinations?	Yes No
Which vaccine caused the reaction?
If YES, what happened?
Has your NI, ever had a bad reaction to any 'spot on' flea treatment?	Yes No
What treatment caused the reaction?
If YES, what happened?
How would you rate you NI`s Temperament?	Excellent Good Fair Poor Bad
How would you rate your NI`s Obedience?	Excellent Good Fair Poor Bad
Is your NI good with people?	Yes No Indifferent
Is your NI good with children?	Yes No Indifferent
Is your NI good with other dogs?	Yes No Indifferent
Is your NI good with other animals?	Yes No Indifferent
Is your NI content to be left alone for short periods?	Yes No
Does your NI travel well in the car?	Yes No
Would you consider your NI:	Nervous Timid Reserved Laid Back Bold Outgoing
Have you any worries concerning your NI?	Yes No
If YES, please give details:
Any Additional comments regarding your NI, you think may be useful to us:
If you have had problems with any of the above, may we contact you to discuss this further?	Yes No
If YES, please leave a contact phone number or / and an e-mail address:
Your Details: *you do not need to complete this section if your prefer to remain anonymous.