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VPC Study Entry
Owner Information
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First Name
Last Name
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Address Line 1
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State/Province
ZIP/Postal Code
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VPC Study Entry Information

I understand that the participation of my dog in this study is voluntary and will be used for research by the Irish Wolfhound Foundation. I understand that I may be asked for additional information and testing that relates to this study (at IWF expense) and agree to provide information on my dog’s health, if possible.

I agree to release the results of the testing to the IWF. I understand that the identity of the dog and owner will not be used in publications but that other information (i.e. age, sex, other ailments or medications) pertinent to the study may be used.

I agree to hold the Irish Wolfhound Foundation and their officers, members and agents, and all employees harmless from any claim for loss or injury which may be alleged to be caused directly or indirectly to any person or dog involved in the testing.

I understand that the testing in this study is for data collection and that, although I may use the results to provide information to any veterinarian treating my dog, the Irish Wolfhound Foundation is not obligated to recommend or provide any treatment.

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By checking this box you are electronically signing this form and agreeing to the study entry conditions specified above:

The IWF will provide you with acknowledgement of your entry and instructions for receiving reimbursement for veterinary care required by the study.

Dog General Information
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Dog Medical Information




Primary Care Veterinarian Information

First Name
Last Name

Address Line 1
Address Line 2
City
State/Province
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Veterinary Cardiologist Information

First Name
Last Name

Address Line 1
Address Line 2
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State/Province
ZIP/Postal Code
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