|
| Akita Name |
|
| Date of Birth |
|
| Date of Death |
|
| Place of Birth |
|
| Sex |
Male
Female |
| Color |
|
| Reason for Death - If
euthanasia, please specify medical, trauma or
behavioral condition - If old age
related please say, old
age. If
stillborn, say, stillborn.
Died within 7 days of birth, please say, fading
puppy. |
Old
Age
Still
Born
Fading
Puppy
Euthanasia
Medical
Trauma
Behavioral
Other:
|
Please list any chronic health
conditions:
Please describe as completely as possible. Please use
correct grammar, punctuation and don't use all caps or
all small letters |
|
| Most commonly fed diet: |
Commercial
Kibble / Dry Dog Food
Premium Kibble / Dry Dog Food
Canned Dog Food
Raw Diet
Home Cooked Diet
Other If other, or a mixed diet please explain:
|
| Supplements: (list 3 most
commonly given) |
Supplement 1
Supplement 2
Supplement 3 |
| Vaccine History: |
All recommended vaccines per year
All
recommended vaccines every other year
Vaccinated only as a puppy
Rabies only
No vaccines ever
Other vaccines given (Lymes, etc.) Please List:
|
| Any vaccines not given, even though
vaccinated regularly: |
|
| Most common vaccines used on a
regular basis, or as recommended: |
|
| Reactions to any vaccination?
Please list the vaccination and the reaction: |
|
| Would you like your Akita remembered
on the Memorial Page listing. |
Yes
No |
|
Is there anything you feel would be
helpful to the Genetic and Health Committee that was
not asked in this form. |
|
