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LCS II Dog Data
Owner Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country

Dog General Information
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Lifetime Cardiac Study II Entry Information

I understand that this data is for research purposes only and will be held confidential by the researchers and the employees of the Irish Wolfhound Foundation. I agree to provide annual updates to the Irish Wolfhound Foundation. I understand that health information and DNA data may be provided to researchers receiving support from the IWF.

I agree to provide a yearly update providing the following information to the IWF: whether the dog is alive or dead; whether the dog has been diagnosed with a serious disease; if dead, the date and cause of death.

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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 a unique study number.

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leave blank if you don't know


(mm/dd/yyyy)
Final Update Information
Please complete this section if your dog, who was entered in the LCS II study, is now deceased. Complete the health section for conditions at time of death.
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if you don't know the exact date, please estimate.
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Dog Health Information
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Please check any conditions which have been diagnosed in your dog

Please check any conditions which have been diagnosed in your dog's sire

Please check any conditions which have been diagnosed in your dog's dam

Please check any conditions which have been diagnosed in your dog's littermate(s)

Dog Diet Information
For an illustrated guide to Body Condition Scores please see https://www.library.tufts.edu/vet/images/bcs_dog.pdf
Select the diet type that best describes the majority of your dog's diet



Medications
Please check any of the following which your dog is taking and provide details (brand, e.g.) in detail boxes