Dog Name

Owner's Last Name

Dog's Zipcode

Name of Veterinarian

Email Address of Veterinarian

Weight

Breed AFFENPINSCHER AFGHAN HOUND AFGHAN/X AFRICIAN WILD DOG AIREDALE TERRIER AIREDALE/MIX AKBASH COBAN KOPEGI AKITA AKITA/X ALASKAN HUSKY ALASKAN MALAMUTE ALASKAN MALAMUTE/MIX ALASKAN MALAMUTE/X AMER COCKER SPAN/X AMER ESK SPITZ AMER ESK SPITZ/X AMER POINTER AMERICAN BULL AMERICAN COCKER SPANIEL/X AMERICAN ESKIMO DOG AMERICAN ESKIMO SPITZ/X AMERICAN FOXHOUND AMERICAN INDIAN AMERICAN PIT BULL TERRIER AMERICAN PIT BULL TERRIER/X AMERICAN STAFFORDSHIRE TERRIER AMERICAN WATER SPANIEL ANATOLIAN SHEPHERD DOG APPHENPINSCHER ARGENTINE DOGO AUSSIE/X AUST CATTLE DOG AUST CATTLE DOG/X AUST HEELER/X AUST SHEP/X AUST SHEPARD AUST SHEPARD/X AUST SHEPHERD AUST SILKY TERRIER AUSTRALIAN CATTLE DOG AUSTRALIAN CATTLE DOG/X AUSTRALIAN KELPIE AUSTRALIAN SHEPARD AUSTRALIAN SHEPHERD AUSTRALIAN SHEPHERD/X AUSTRALIAN SHEPHERD/X AUSTRALIAN TERRIER BASENJI BASENJI/X BASSET HOUND BASSET HOUND/MIX BEAGLE BEAGLE/BOXER BEAGLE/X BEARDED COLLIE BEARDED COLLIE/X BEAUCERON BEDINGTON TERRIER BEDLINGTON TERRIER BELGIAN MALINOIS BELGIAN SHEEPDOG BELGIAN SHEEPDOG/X BELGIAN TERVUREN BERGAMASCO BERGER PICARD BERNESE MOUNTAIN DOG BERNESE MTN DOG/X BERNESE/X BICHON FRISE BICHON/X BLACK AND TAN COONHOUND BLACK RUSSIAN TERRIER BLOOD HOUND BLOODHND BLOODHOUND BLOODHOUND/X BLU TIC COONHOUND BLUE TICK HOUND BLUE TICK HOUND/X BOLOGNESE BORDER COLLIE BORDER COLLIE/X BORDER TERRIER BORZOI BORZOI/X BOSTON TERRIER BOSTON TERRIER/X BOUVIER DES FLANDRES BOUVIER DES FLANDRES/X BOXER BOXER/MIX BOYKIN SPANIEL BRIARD BRIARD/X BRIT SPAN/X BRIT SPANIEL BRITTANY SPANIEL BRITTANY/X BRITTANY/X BRUSSELS GRIFFON BRUSSELS GRIFFON/MIX BULL MASTIFF BULL MASTIFF BULL MASTIFF/X BULL TERRIER BULL TERRIER, ENGLISH BULL TERRIER/MIX BULL TERRIER/X BULLDOG BULLDOG, AMERICAN BULLDOG, ENGLISH BULLDOG, FRENCH BULLDOG/X CAIRN TERR/X CAIRN TERRIER CAIRN TERRIER/X CANAAN CANAAN DOG CANE CORSO CATAHOULA HOG DOG CATAHOULA LEOPARD DOG CATAHOULA LEOPARD/X CATALAN SHEEPDOG CAVALIER KING CHARLES SPANIEL CENTRAL ASIAN SHEPHERD CESKY TERRIER CHESAPEAKE BAY RETRIEVER CHESAPEAKE BAY RETRIEVER/X CHIHUAHUA CHIHUAHUA CHIHUAHUA, LONG HAIRED CHIHUAHUA/MIX CHIHUAHUA/X CHINESE CRESTED CHINESE CRESTED/MIX CHINESE PUG/MIX CHINOOK CHOW CHOW CHOW/X CLUMBER SPANIEL COCKAPOO COCKAPOO/X COCKER SPANIEL, AMERICAN COCKER SPANIEL,ENGLISH COCKER/X COLLIE (ROUGH) COLLIE X COLLIE, ROUGH COLLIE, SMOOTH COLLIE/X COON HOUND COON HOUND COONHOUND COONHOUND/X CORGI/X CORGIE/MIX COTON DE TULEAR CURLY COATED RETRIEVER DACHS DACHSHUND DACHSHUND, LONG HAIRED DACHSHUND, MINI, LONG HAIRED DACHSHUND, MINIATURE DACHSHUND, WIREHAIRED DACHSHUND/TERRIER DACHSHUND/X DACHSUND/X DALMATIAN DALMATIAN DALMATIAN/X DANDIE DINMONT TERRIER DANDIE DINMONT/X DINGO DINGO/X DOBERMAN PINSCHER DOBERMAN PINSCHER/MIX DOBERMAN PINSCHER/MIX DOBIE/X DOGO DOGUE DE BORDEAUX DRAHTHAAR DRATHAAR ELKHOUND/X ENG ENG BULL TER ENG POINTER ENG POINTER/X ENG SPR SPAN ENG SPR SPAN/X ENG TICK HND ENGLISH BULLDOG/X ENGLISH COONHOUND ENGLISH FOXHOUND ENGLISH POINTER ENGLISH SETTER ENGLISH SETTER/X  ENGLISH SHEPHERD ENGLISH SPRINGER SPANIEL/X ENGLISH TERRIER ENGLISH TOY SPANIEL ENTLEBUCHER MOUNTAIN DOG ERROR ESKIMO ESKIMO/X FIELD SPANIEL FILA FINNISH LAPPHUND FINNISH SPITZ FLAT COATED RETRIEVER FOUSEK FOX TERR/X FOX TERRIER FOX TERRIER, SMOOTH FOX TERRIER, TOY FOX TERRIER, WIREHAIRED FOX TERRIER/X GER SHEP/X GER SHORT HAIRED POINTER GERMAN SHEPHERD DOG GERMAN SHEPHERD, LONG HAIRED GERMAN SHEPHERD/X GERMAN SHORTHAIR POINTER GERMAN SHORTHAIRED POINTER GERMAN SHORTHAIRED POINTER/MIX GERMAN WIREHAIRED POINTER GERMAN WIREHAIRED TERRIER GIANT SCHNAUZER/X GOLDEN RETRIEVER GOLDEN RETRIEVER  GOLDEN RETRIEVER/X GORDON SETTER GORDON SETTER/X GRAND BASSET GRIFFON VENDEEN GREAT DANE GREAT DANE/X GREAT PYRENEES GREAT PYRENEES/X GREYHOUND GREYHOUND/X GROSSER MUNSTERLANDER HARRIER HAVANESE HEIDEWACHTEL HERD HOUND HOUND/SHEP/X HOUND/X HOVAWART HUNGARIAN SHEEPDOG HUSKY/SHEP IBIZAN HOUND ICELANDIC SHEEPDOG IRISH SETTER IRISH SETTER/X IRISH STAFFORD BULL TERRIER IRISH TERRIER IRISH TERRIER/X IRISH WATER SPANIEL IRISH WOLF HOUND/X IRISH WOLFHOUND IRISH WOLFHOUND/X ITALIAN GREYHOUND JACK RUSSEL TER/X JACK RUSSELL TER/X JACK RUSSELL TERRIER JAP BOB TAIL JAPANESE CHIN JAPANESE SPANIEL JINDO KAI LEO KARELIAN BEAR DOG KARELIAN BEAR DOG  KEESHOND KEESHOND/SHEP/X KEESHOND/X KEESHOND/X KELPIE KELPIE/X KERRY BLUE TERRIER KOMONDOR KOMONDOR/X KOREAN JINDO DOG KUVASZ KYI LEO LAB/SHEP LABRADOR RETRIEVER LABRADOR RETRIEVER/X LABRADOR/MIX LABRADOR/X LAGOTTO ROMAGNOLO LAKELAND TERRIER LEONBERGER LEONBEWERGER LEONBURGER LG MUNSTERLANDER LHASA APSO LHASA APSO/X LHASA APSO/X LHASA APSO/X LLEWELLIN SETTER LONG H MIN DACH LONG H MIN DACHS LONG HAIR STAN DACH LONG HAIRED ROTTWEILER LONG HAIRED ST BERNARD LOWCHEN LURCHER MALTESE MALTESE/X MANCHESTER TERRIER MANCHESTER TERRIER/X MAREMMA MASTIFF MASTIFF/X MCNAB MCNAB/X MID-ASIAN OVTCHARKA MIN DACHS MIN DOBERMAN/X MIN PINSCHER/X MINATURE DOBIE MINIATURE DACHSHUND MINIATURE PINSCHER MINIATURE POMERANIAN MINIATURE POODLE/X MIX MIXED MIXED BREED MUDI NEAPOLITAN MASTIFF NEWFOUNDLAND NORFOLK TERRIER NORWEGIAN ELKHOUND NORWEGIAN ELKHOUND/X NORWICH TERRIER NORWICH TERRIER/X NOVA SCOTIA DUCK TOLLING RET OLD ENGLISH MASTIFF OLD ENGLISH SHEEPDOG OLD ENGLISH SHEEPDOG/X OTTER HOUND PAPILLON PAPILLON/X PATTERDALE TERRIER PEKAPOO PEKE PEKE/POODLE PEKE/X PEKINGESE PEKINGESE/MIX PEKINGESE/X PETIT BASSET GRIFFON VENDEEN PHARAOH HOUND PIT BULL TERRIER PIT BULL/X PLOTT HOUND PLOTT HOUND/X POINTER POINTER/X POLISH SHEEPDOG POMERANIAN POMERANIAN/MIX POODLE POODLE, FRENCH POODLE, MINIATURE POODLE, STANDARD POODLE, TEACUP POODLE, TOY POODLE/X PORTUGUESE WATER DOG PORTUGUESE WATER SPANIEL POSA PUDELPOINTER PUG PUG CHINESE PULI PULI/X PUMI PYRENESE/X QUEENS/X QUEENSLAND HEELER QUEENSLAND HEELER/X QUEENSLAND/X RAT TERRIER RAT TERRIER/X RED BONE HOUND RED BONED HOUND/X RED TICK HOUND REPLACE RET/RIDGEBACK/X RETRIEVER/X RHOD RIDGEBACK/X RHODESIAN RIDGEBACK RHODESIAN RIDGEBACK/X ROTT/CHOW ROTTWEILER ROTTWEILER/X ROUGH COLLIE SAINT BERNARD SAINT BERNARD/MIX SALUKI SALUKI/X SAMOYED SAMOYED/X SARPLANINAC SCHIPPERKE SCHIPPERKE/X SCHNAUZER SCHNAUZER, GIANT SCHNAUZER, MINIATURE SCHNAUZER, STANDARD SCHNAUZER/X SCOT TER/X SCOTTISH DEERHOUND SCOTTISH TERRIER SCOTTISH TERRIER/X (SCOT TER/X) SEALYHAM TERRIER SETTER/X SHAR PEI SHAR PEI/X SHEBA INU SHEEPDOG/X SHELTIE/BORDER COLLIE X SHEP/CHOW SHEP/CHOW/X SHEP/KEESHOND/X SHEP/X SHEPARD/LAB/X SHEPHERD SHETLAND SHEEPDOG SHETLAND SHEEPDOG/MIX SHIBA INU SHIH TZU SHIH TZU SHIH TZU SHIH TZU/X SIB HUSKY/X SIBERIAN HUSKY SIBERIAN HUSKY WOLFHUSKY/X] SIBERIAN HUSKY/MIX SIBERIAN HUSKY/X SILKY TER/X SILKY TERRIER SKYE TERRIER SLOUGHI SMOOTH COAT COLLIE SOFT COATED WHEATEN TERRIER SPAN SPANIEL SPANIEL/X SPANISH POINTER SPANISH WATER DOG SPINONE ITALIANO DOG SPITZ/POODLE SPITZ/X SPRINGER SPANIEL, ENGLISH SPRINGER SPANIEL, WELSH SPRINGER/X STAFF TERR/X STAFFORDSHIRE TERRIER STAFFORDSHIRE TERRIER/X SUSSEX SPANIEL SWEDISH VALHUND SWISS MOUNTAIN DOG TAIWANESE DOG TERR/X TERRIER TERRIER TERRIER X TERRIER/X TERRIER/X TESTING AGAIN TIBETAN MASTIFF TIBETAN SPANIEL TIBETAN TERRIER TIBETAN TERRIER/X TOLLER RETRIEVER TOLLING DOG TORNJAK TOSA TOY MANCHESTER TERRIER TOY POODLE/X TOY TERRIER UNKNOWN VIZSLA VIZSLA/X WALKER HOUND WEIMARANER WEIMARANER/MIX WELSH CORGI WELSH CORGI, CARDIGAN WELSH CORGI, PEMBROKE WELSH TERRIER WEST HIGHLAND TERRIER/X WEST HIGHLAND WHITE TERRIER WHEATEN TERRIER WHEATEN TERRIER/X WHIPPET WHIPPET/X WILD ISLAND DOG WIRE H. FOX TERR/X WIRE HAIRED DACHS WIRE HAIRED MIN DACH WIREHAIRED FOX TERRIER/X WIREHAIRED POINTING GRIFFON WOLF WOLF/X WOLFHOUND/X XOLOITZCUINTLI YOLO DOG YORKSHIRE TERRIER YORKSHIRE TERRIER/MIX YORKSHIRE TERRIER/X

Sex

Male
Female

Microscopic Agglutination Test I do not have MAT Negative 1:100 1:200 1:400 1:800 1:1600 1:3200

Hematoerit

Hemoglobin

MCV

WBC

Bands

Neutophils

Lymphocytosis

Monocytes

Eosinophils

Platelet Count

Anion Gap

Sodium

Potassium

Chloride

Bicarb

Phosphorous

Calcium

BUN

Creatinine

Glucose

Total Protein

Albumin

Globulin

ALT

AST

ALP

GGT

Cholesterol

Bilirubin

Urine Specific Gravity

Urine Protein


Urine Glucose