Welsh Terrier Health Incident/Death Report

This report will provide owners with a form for documenting health-related incidents and causes of death in their Welsh Terriers.   It will assist the WTCA in its search and selection process for researchers who are studying health problems that affect the breed.

If you want to be ANONYMOUS, you MUST type "ANONYMOUS" and anon@xyz.com in the following identifier boxes.

Please enter your name or ANONYMOUS (Required):                  

Please enter your Email Address or anon@xyz.com (Required):

CONDITION/CIRCUMSTANCES: Describe the occurrence, time of day, signs, symptoms, duration, medications, veterinary recommendations and outcome. (continue in “OTHER COMMENTS” if more space is needed)

Date of event or death:

Have you notified your breeder?

YES
NO

Age of your Welsh Terrier:

Less than 1 Year
1 to 5 yrs.
5 to 10 yrs.
10 to 15 yrs.
Over 15 yrs.

Is your Welsh Terrier:

Male             Female
Intact           Spayed      Neutered

Has your Welsh terrier ever been bred?

Yes
No

What do you feed your Welsh Terrier? (Check all that apply)

Dry, commercial dog food.
Wet, commercial dog food.
Other e.g. home made, organic/natural, prescription, frozen
 

What immunizations has your Welsh Terrier received?
(Check all that apply.)

DHPP Year of last booster:
DHLPP Year of last booster:
Rabies Year of last booster:
Bordetella Year of last booster:
Others Names and Years:
                  

 

 

 

Do you use a flea/tick preventative?

Yes
No

Do you use an oral heartworm preventative?

Yes
No

Do you use an injectable heartworm preventative?

Yes
No

In what part of the country does your Welsh terrier reside?

North
South
East
West
Other (Name Country)     Country:

OTHER COMMENTS:

I am willing to be contacted privately to provide further information:

Yes
No

E-Mail Address:

Telephone number

Day    Evening
 

Thank you.