PF Questionnaire Page

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I have a designed this Questionnaire (though somewhat lengthy it's very important) to help us look for any connections amongst PF cases in German Shepherd Dogs and other breeds who have been afflicted.

IMPORTANT!!

We also need healthy dog pedigrees!! If you have a dog who is deceased and never had PFs please send us your dog(s) pedigree snail mail to: CANINE RESEARCH DATABASE, Attn: PF Dogs, 298 S.W. Franklin St., Berlin, WI 54923 USA

Please fill out as completely as possible (give details) and answer ALL of the questions. Each one is very important. Thank You!

Your full name:
Your email address:

Your phone number (with area code), strictly confidential:

Address:
City/Town: State/Prov.: Post / Zip Code:
Country:

Dog's Name

Dog's current age?

Dog's birthdate?

Age when PFs occurred?

Give date PFs were diagnosed by Vet?

Sex (neutered or spayed)?

What was your dog's weight prior to PFs?

Was your dog ever bred?
YESNO


If yes, please give details (how many times, produce other PF dogs, produce other problems, ect.) .

What breed is your dog?

If German Shepherd is it American bloodline, German bloodline or unknown?

Will you be supplying a copy of your dog's pedigree for the research into PFs?
YESNO


Do you know if any close relatives to your dog suffer from PFs?
YESNO


If yes, please give details of who.

How did you come to know your dog had PFs (describe symptoms/behavior seen)?

Did your dog ever experience anal gland problems (licking, scooting, impacting) or need anal glands expressed prior to PFs?
YESNO


If so describe and tell how often?

Did your dog have any constipation/diarrhea/bloody stool (Explain)?

Does your dog appear to pass gas more or less since PFs appeared?

Has your dog ever suffered from ear infections or itchy skin(Describe)?

Does your dog suffer from food or other allergies (Describe)?

Has your dog been thyroid tested (Give results)?

Please describe any other illness your dog has had?

Has your dog ever suffered an injury and if so explain?

Does your dog have any other medical condition and if so please describe?

Has your dog ever undergone Anal Gland or PF surgery and if so explain?

What treatments have you used to treat the PFs (Be very specific and give as much detail as possible, including dates if you changed treatments.)?

Were any successful and how?

Has your dog's weight changed (give explanation)?

Has your dog shown any side effects from any treatments used (Be very specific)?

Has your dog shown any change in behavior since getting PFs?
YESNO


If yes, please explain how.

When and what vaccinations does your dog get (Please give dates and vaccine names)?

Does your vet give the vaccines separately or in a combination using live, killed or modified live?

Have there been any changes in your dog's life / environment, or your household?

Has your dog been through obedience training, (if so at what age)?

Is your dog ever boarded at a kennel or the vet's (how often)?

Has your dog ever been in a dog fight?

Do you use flea prevention products on your dog?
YESNO


If yes, give details.

What food do you feed your dog?

Have you changed your dog's diet and if so how?

What treats do you give your dog?

What, if any vitamin supplements do you give your dog?

Is this your first PF dog?
YESNO


If no, please fill out this form for each PF dog.

Have you joined our extremely informative PF-L on ONElist.com where you will learn how to care for your PF dog?
YESNO


Where did you learn of the PF Website?

COMMENTS:

Thank you for taking the time to complete this very important questionnaire. The information you have provided is helping in the research of PFs.

Please click Submit button only once.

If you have any questions please Email Me

Copyright 1999 DJ Hensch

Last updated February 28. 2001

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