Cane Corso Seizure DNA Submission
Link to Sample Collection Instructions
Dog Owner's Full Name
*
First Name
Last Name
Dog Owner's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Dog Owner's Email
*
example@example.com
Dog's Name
*
Dog's Date of Birth
*
-
Month
-
Day
Year
Date
Dog's Gender
*
Female
Male
Approximate Date of First Seizure
*
-
Month
-
Day
Year
Date
Is the dog sample being submitted an affected dog?
*
Yes
No
Is the sample submitted related to an affected dog?
*
Yes
No
Diagnosing Veterinarian's Name
*
Diagnosing Veterinarian's Phone Number
*
If the dog has passed, was a necropsy performed? Please include the necropsy report, if available.
*
Yes
No
Necropsy report, if available.
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Was an MRI performed after diagnosis? Please include the MRI report, if available.
*
Yes
No
MRI report, if available.
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Was a blood test taken after a seizure episode? Please include the blood test report, if available.
*
Yes
No
Blood test report, if available.
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What type of sample are you submitting?:
*
Blood
Tissue
Frozen Semen
Please check each box to ensure proper submission
*
Sample is packed according to Submission Outline.
This form and all corroborating documentation is attached securely in an envelope on the outside of the shipping box. Please mark "Cane Corso" on outside of envelope with dog's name.
Dog's pedigree must be included to ensure correlations of family lines.
Proper shipping information is located on the outside of the box.
Shipping:
*
Dr. Gary Johnson - (Cane Corso) DNA Research, 320 Connaway Hall, University of Missouri, Columbia, MO 65211
Neither sample collection nor packing supplied are provided and are the responsibility of the owner.
Shipping OVERNIGHT is required to ensure the sample is received properly. DO NOT ship on Fridays! No technician is at the lab to receive samples on weekends.
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