ON-LINE SURVEY OF OWNERS OF DALMATIANS
Section 2 -- Dog Info ONLY

INSTRUCTIONS: 1. Please skip any questions for which a response is NOT available. 
  2. When entering information please highlight the entire info already there (e.g. select, treats, areacode, etc.) and then enter the information requested.
  3.

Sections  -- 
  2 General Dog Info
  3 Fill-in ONLY if your dog had/has STONES
  4 Fill-n ONLY if your dog has Urate or Xanthine stones
  5 Fill-in ONLY if your dog DOES NOT or DID NOT have stones.

  4. Click "SUBMIT" when you are done
  5. If you do not receive a "THANK YOU" message after you've submitted your information please let us know. Your submission probably did not go through.

 

SURVEY NAVIGATION PAGE | OWNER SURVEY | DOG SURVEY | SURVEY HOME | COLLEGE OF VET MED HOME | QUIT

SECTION 2 -- DOG INFO

  Area Code/Telephone (country/area code may be put in the "AREA CODE" box:
(REQUIRED)		 ( )    Telephone: 
     
  Dog's Call Name/Nickname:    Breed: 
  Sex
    -- If neutered or spayed please indicate AGE
       at which procedure was carrried out:
  Date of Birth: (MM-DD-YYYY)
    -- If deceased please enter Date of Death: (MM-DD-YYYY)
  Registered w/American Kennel Club?
  Registered Name (if known):
  SURVEY QUESTION:  
  Has your dalmatian had stones?
 

SECTION 3 -- DOG WITH HISTORY OF STONES
  Please enter the YEAR of your dog's first episode of stone disease (example: 1990, 1998, etc.)
  Were the stones: 
  What diet was fed primarily prior to the first episode of stone disease? 
 
  Please list info regarding diet:

  What was your dog's primary source of water prior to the first episode of stone disease? 
 
  Did you give bottled water prior to the first episode of stone disease?  
  Was your dog receiving any medication just prior to or at the time of the first episode of stone disease?    
  If YES, what medication(s):
     
 

Did you monitor your dog's urine pH prior to the first episode of stone disease?      
  Did you monitor our dog's pH at home?      
  Did you take your dog to your veterinarian for analysis of urine samples on a routine basis?       
  If YES, how often?     

     
  What was the composition of the stones?   
  If OTHER, please list:
     
 

SECTION 4 --
YOU SHOULD FILL OUT THIS PAGE ONLY IF  YOUR DOG HAD URATE OR XANTHINE STONES
     
  What diet do you feed your dog in order to prevent stones from recurring? 

  Please list DIET INFORMATION:
     
  Do you give medication to prevent urate stones routinely to your dog?     
 

If YES, please check off all that apply.
Allopurinol 


Potassium citrate

Sodium Bicarbonate

OTHER

 
  If OTHER, please list:   
     
  Have you discontinued all treats?  
  If NO, what treats do you give:
  How often?
     
  Do you add water to your dog's diet?          
Do you use bottled water instead of tap water?    
  If YES, labeling on bottled water is -- 
     
  Do you monitor your dog's pH at home?        
Do you take your dog to your vet for analysis of urine samples on a routine basis?   
  If YES, how often? 
     
  After the first episode of stone disease, has your dog had another occurence?   
  If YES, what was the stone type? 
 
  If OTHER, please briefly describe
  If YES, when was the occurence?  years ago
 
  Describe, briefly, how the recurrence was managed?
............
     
  Has your dog had any other recurrences of stones?       
  Please list each additional recurrence (Date, Type of Stone, Management) below.
............
     
     
 

NOTE: This questionnaire will be used for data collection purposes only. Your name, kennel name, and/or dog's name will NOT be published or made available to anyone outside of this research group. Names and other information are gathered for the purpose of contacting you for more informatoin if needed.

Thank you for your participation.

     
 

SECTION 5
-- YOU SHOULD FILL OUT THIS SECTION ONLY IF YOUR DOG DID NOT HAVE STONES
     
  What diet do you or did you primarily feed your dog?  
  Please list diet brand, ingredients, or other raw food diet:
............
     
  Do you give treats routinely? 
  If YES, what treats do you give? 
  How often?     
     
 

What is your dog's primary source of water?         
Do you add water to your dog's diet?          
Do you use bottled water instead of tap water?          
  If YES, labeling of bottled water is:   

Do you give medication to prevent urate stones routinely to your dog?     
 

If YES, please check off all that apply.
Allopurinol 


Potassium citrate

Sodium Bicarbonate

OTHER

 
  If OTHER, please list:   

     
  Do you monitor your dog's pH at home?          
Do you take your dog to your vet for analysis of urine samples on a routine basis?     
  If YES, how often? 
     
  Please list each additional information that you feel is important:
 
     
 

NOTE: This questionnaire will be used for data collection purposes only. Your name, kennel name, and/or dog's name will NOT be published or made available to anyone outside of this research group. Names and other information are gathered for the purpose of contacting you for more informatoin if needed.

Thank you for your participation.

Please click on the SUBMIT button below.