Survey

We're having some difficulties with our webhost so the data from this form isn't being sent to our coordinator the way
it should be. Until we can get the form working, please e-mail the following information to trillhill@aol.com
or use the printable version and mail it to Karen at the address down below. Sorry for the inconvenience...

We are asking everyone that has a Shiloh Shepherd to fill out this survey with
as much information as possible. Our goal is to enter every Shiloh Shepherd into the database.

We need information on every dog out there, not just the ones with diseases, but the healthy ones too!
The more information that we collect, the better the overall picture of our breed will be...

We're also looking for information on previous dogs you may have had. If you've had
Shilohs that have passed on to the Rainbow Bridge, please send us the information about
them too, but include a note in question #22 (the comments section) telling us that the dog
is deceased, what the cause of death was and the dogs age at the time it passed away.

Our goal is to eradicate genetic diseases from our breed and with your help we can do it!

If you would prefer a copy of the survey that
you can print out and mail to us, please click here.

1) Is your dog ISSR Registered?
Yes No

2) Is your dog a Male or Female?
Male Female

3) Is your dog Spayed or Neutered?
Yes No

4) What is your dog's callname?

5) What is your dog's full registered name?

6) What is your dog's registration number?

7) What is your dog's date of birth?
-- mm/dd/yy

8) What kennel did you get your dog from?

9) What is your dog breeder's name?

10) How was your dog identified in the litter or during the LER?
(Ex: red collar, green collar, etc.)

11) Does your dog have New Blood?

12) If your dog is the result of another outcross, please provide the breed name,
registration information and any other information you think could help.

13) What is the Dam's callname?

14) What is the Dam's full registered name?

15) What is the Sire's callname?

16) What is the Sire's full registered name?

17) If you know it, how many puppies were born in the litter?

Males:
Females:

18) What coat color is your dog?

19) What coat type does your dog have?

20) Has your dog been diagnosed with any diseases?

21) If your dog has been diagnosed with any diseases please include the following information here:

a) What disease was diagnosed?

b) Who diagnosed this disease.

c) The diagnostic method if known. e.g. Bloodwork, Radiographic, ECG, Observation, etc.

d) Was this an acquired or genetic disease?

e) The age of the dog at the diagnosis or onset of the disease.

22) If your dog was OFA or PennHIP certified or if you had
your own vet read the x-rays, what were the results?

Hips:
Elbows:
Dog's age at time of x-ray:

My dog's x-ray was read by:

23) Would you like to provide any additional comments?
Some things we would be interested in:

Has your dog had other health problems or genetic faults,
such as chronic diarrhea, ear infections, carsickness,
soft ears, hook tail, etc.

24) Is your dog a known carrier of a disease, even if the dog doesn't have the disease itself?
Please explain:

a) My dog has/has not produced the following diseases:
(list) when bred to (please name his/her mate).

b) In the first litter there were puppies produced (enter total # of puppies)
and were affected (enter # of affected puppies).

1) This breeding was/was not repeated and a total puppies (enter # of puppies)
were produced with being effected (enter number of affected puppies.

c) My dog was also bred to the following stud/bitch
(name) (date)
and a total of puppies were also affected with
(enter name of disease).

d) All of the above information has been fully documented via individual reports submitted to
the GTF via the survey: Yes No

25) Please let us know if this is the first time you've filled out this survey
for this particular dog, or if this is an update of information:
First time Update

26) Please provide us with a way to contact you if we should have any
questions about the information you've provided in this survey.

NOTE: If you've filled out surveys for other dogs you don't need to
re-type all the information below, just type in your name and in the
Kennel Name area, type "See others".

Owner's Name
Kennel Name
Work Phone
Home Phone
E-mail Address
Website URL

27) Do you have any questions? Would you like someone from the
Genetics Task Force Committee to contact you about your dog?
Yes No

You can also print out and mail your completed report to:
ISSR, Inc.
c/o Karen Ursel
6271 Footes Corners Rd.
Conesus, NY 14435

PLEASE NOTE:
The information collected in this survey is for the good of the Shiloh Shepherd breed.
We appreciate your cooperation in filling out this survey. We will not sell this list
or allow anyone to use it for advertising purposes.

Your dog’s private information will not be accessed by anyone other than
ISSR officials who sort the data received and preparing final statistical
reports like the ones already available on our website.

Dedicated to improving the health of ISSR Shiloh Shepherds.

Copyright © 1998 - 2009. Shiloh Shepherd Dog™ Club of America.
All rights reserved. Revised: January 2008

The information on this website was written by ISSR breeders and other concerned individuals, however we are are NOT veterinarians. This information is being provided as a general overview, from information we were able to find about each disease through our own research. These summaries are not intended to be relied upon as medical or veterinary advice, nor do we consider ourselves experts in the veterinary field or in any of these conditions. While we do our best to provide the most up to date information, new research is constantly being done on these diseases. We recommend that you do further study and talk to your veterinarian on any topics you see here, as we cannot guarantee that the information posted here is the most current information available. This site was originally designed and maintained by Debbie Knatz.