UK Siberian Husky - Health Survey
  STAGE 1
  Will be to identify the number of dogs overall which have developed Glaucoma. Please give as much of the following information as possible. Thank you
  About you and your dog :
  Owners Name (first, last)
  E-mail Address
  Telephone number
  Kennel Name of Dog/Bitch
  Date of Birth / /
 
  Assessment details :
  Glaucoma diagnosed ? No Primary Secondary
  Clear certificate before developing glaucoma Yes No
  Pre-disposed certificate before developing glaucoma Yes No
  Tested before developing glaucoma Yes No
  Eyes Affected None Right Left Both
  Right Eye Colour Blue Brown Parti/Marbled
  Left Eye Colour Blue Brown Parti/Marbled
  When did glaucoma develop? None 1 - 5 yrs 6 yrs +
  Aware of either parent being predisposed before or after your dogs DOB Yes No
  Are you aware of any siblings being pre disposed Yes No
  Are you aware of any siblings being affected Yes No
   
  STAGE 2
  Is relevant to tested predisposed dogs and their subsequent history.  Please give as much of the following information as possible. Thank you
  About you and your dog :
  Kennel Name of Dog/Bitch
  Date of Birth / /
 
  Assessment details :
  Date tested / /
  Date of re-test / /
  Date of final test / /
  Predisposed None Left Right Both
  Has the predisposition progressed since first tested Yes No
  Has the predisposition regressed since first tested Yes No
  Right Eye Colour Blue Brown Parti/Marbled
  Left Eye Colour Blue Brown Parti/Marbled
  When did glaucoma develop? None 1 - 5 yrs 6 yrs +
  Aware of either parent being predisposed before or after your dogs DOB Yes No
  Are you aware of any siblings being pre-disposed Yes No
  Are you aware of any siblings being affected Yes No
     
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