Texas A&M University

College of Veterinary Medicine

Registered Name of Dog/nom du chien/name des Hundes/nome del cane  __________________________________________________________                                                                    

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Call Name of Dog/dit/genannt/dito_________________________ DOB/Né le/WT/nato__________________

Sex/Sexe/Geschlecht/sexo___________  Color/couleur/Farbe/colore_________________________________

Weight/poids/Gewicht/Peso__________ Height/taille/Grösse/taglia___________________________________

Registered Name & Number of Sire + color/nom du père et n° de pedigree+couleur/Name des Vaters und ZB-Nr+ Farbe/ nome del padre + n° del LO+ colore ______________________________________________________________________________________________ 

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Registered Name & Number of Dam+color/nom de la mère et n° de pedigree+couleur/Name der Mutter und ZB-Nr+Farbe/ nome della madre + n° del LO +colore ______________________________________________________________________________________________

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Number of Siblings in Litter/nombre de chiots dans la portée/Welpenanzahl im Wurf/numero degli cuccioli della cucciolata _______________

History of Cardiac Health/historique de l'état cardiaque/Bisherige Herz diagnose/Storia di salute cardiaca ______________________________________________________________________________________________

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Name of Owner(s)/ nom du propriétaire/ Besitzername/ nome del proprietario_______________________________ ______________________________________________________________________________________________

Address/adresse/Anschrift/Indirizzio_________________________________________________________________

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Phone/téléphone/telefon/telefono___________________________________________________________________

Email_________________________________________________________________________________________

May we contact you for further information, if necessary?/ pouvons nous vous contacter en cas de besoin d'information complémentaire ?/ dürfen wir uns melden, falls notwendig?/possiamo contattarli in caso di bisogno___________________

Preferred Contact Method (Phone, Email, Mail)/par téléphone,mail ou courrier/Telefon, mail oder Post?/telefono, mail o lettra?_______________________