Clumber Spaniel Health Report Form
All information given will be kept strictly confidential and no personal information will be shared with other parties.

Please fill in this form if your Clumber Spaniel has been diagnosed with an illness or condition so that we may discover the most common complaints within our beloved breed.
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Email *
What is your dogs pet name? *
What is your dogs Kennel Club Registered name? (optional)
Is your dog male or female? *
What is your dogs date of birth? *
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DD
/
YYYY
Has your dog had any of the following conditions? (please tick all that apply) *
Required
If 'other', please specify here
Please give further information on your dogs condition, including age at diagnosis, if it is managed with medications, how the condition affects your dog. *
What symptoms did your dog show at the start of their illness that made you take them to the vet?
Has your dog ever been used for breeding purposes? *
If your dog has been spayed or neutered, what age were they at the time?
Clear selection
May Clumber Spaniel Health contact you via email for further information on the condition your dog has? *
Where do you live? *
If 'other' was selected above, please state country here
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