Health Questionnaire Stabyhoun Health Questionnaire BACKGROUND INFORMATIONOwner's Name(Required) First Last Email(Required) Dog's Name(Required) Call Name Dog's Registration Number (If known) Dog's Date of Birth MM slash DD slash YYYY Dog's Date of Death (if applicable) MM slash DD slash YYYY Sex of Dog(Required)Male - IntactMale - NeuteredFemale - IntactFemale - SpayedPlease select one optionHow did you obtain your Stabyhoun?(Required)I bred the litterFrom ASA breederFrom abroadRescueOtherWhat activities does your dog participate in? Agility Barn Hunt/Field/Nosework Obedience Rally Therapy Dog Fast Cat Other GENERAL HEALTH OF YOUR STABYHOUNHas your Stabyhoun had any significant health issues?(Required)YesNoHow would you rate the overall health of your Stabyhoun?(Required)ExcellentGoodFairPoorTerribleIf yes, please give details:Is your dog on flea protection?(Required)YesNoIf yes, what brand? Is your dog on tick protection?(Required)YesNoIf yes, what brand? Is your dog on heartworm medicine?(Required)YesNoIf yes, what brand? Is your dog vaccinated regularly ?(Required)YesNoIf Yes, which vaccines does your dog receive? Distemper/Parvo virus Rabies Kennel Cough Leptosirosis Lyme Disease Canine Influenza Other If “No”, do you have titers checked instead of vaccinating?YesNOHas your dog had any adverse reaction to any vaccines?YesNOIf yes, which ones? Has your dog ever had surgery?YesNoIf yes, what procedures? Has your dog ever been anesthetized?YesNoIf “yes” any adverse reactions? Please describe and list drugs used, if known.What type of food does your dog eat? Kibble Moist canned Home Cooked Raw food If you feed a commercial diet, which brandsWhat dietary supplements do you give your dog? Joint Skin/Coat Teeth Digestive (probiotics) Other If other, please describe. What health issues do you think are most important or serious in the Stabyhoun breed and why?BREEDING HEALTH STATUSHas your dog given birth to or sired puppies?YESNOIf so, has your Stabyhoun produced pups with birth defects or congenital problems (i.e. cleft palate, elbow dysplasia, hip dysplasia, PDA, etc)?YESNOIf Yes, please specify :Has your dog produced any stillborn puppies?YESNOGENETIC HEALTH TESTING OF YOUR STABYHOUNWhich of these tests have you had performed on your Stabyhoun (recommended at 2 years of age)? HIPS - OFA HIPS - PENNHIP HIPS -OTHER ELBOWS - OFA ELBOWS - OTHER EYES - CERF EYES - OTHER HEART - OFA HEART - stethoscope HEART - DOPPLER HEART - Echocardiogram HEART - OTHER SPECIFIC HEALTH ISSUES OF YOUR STABYHOUNPlease check if your Stabyhoun is having issues or has been diagnosed with any of the following health problems. If yes, please explain in detail on the lines provided. Please check all that apply.PLEASE CHECK ANY THAT APPLY TO YOUR DOG. Eye problems (e.g. cataracts, glaucoma, cherry eye, entropion, chronic infections, eyelid tumor) Ear infections Dental problems ( gingivitis/periodontal disease; underbite, overbite, missing teeth, other) Skin issues not related to allergies Allergies (e.g., environmental allergies, flea allergy, other) Cardiovascular disorders (e.g. heart; including murmurs, PDA, heartworm disease, heart failure, others Respiratory (breathing issues unrelated to cardiac) GI (stomach, intestine) disorders e.g. IBD, ulcers, food hypersensitivity Urogenital- (e.g.kidney disease, chronic urinary tract infections, bladder calculi, incontinence) Liver Disease Endocrine diseases (e.g. Thyroid, diabetes, Cushing’s, Addison’s other) Neurologic disorders (including epilepsy, nystagmus, disc disease, muscle weakness) Immune system problems (SMRA, IMHA, ITP or other autoimmune) Bone/Joint problems (including osteoarthritis, elbow dysplasia, hip dysplasia, others Reproductive disorders ( e.g. metritis, retained testicle, benign prostatic hypertrophy, mastitis, others) Congenital or inheritable diseases not mentioned above-e.g. kink in tail, missing toe, vWD Cancer or tumors -spleen, liver, skin, other Drug Reactions (confirmed or suspected Detailed Explanation of my Stabyhoun’s health issues (see above):TEMPERAMENT OF YOUR STABYHOUNPlease check all that apply to your Stabyhoun:. Aggression to other dogs (includes provoked by staring, territorial aggression, etc) Aggression toward people Prey aggression (intense chasing of smaller animals with “intent to kill”) Dominance toward other dogs (assertive but will not physically harm other dog unless challenged) Separation anxiety Shy with new people Fearful of objects OTHER TEMPERAMENT CHARACTERISTICS TO SHARE?Thank you so very much for sharing your Stabyhoun’s health history with the ASA; this information is invaluable to us. Δ
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