UDC HEALTH CLINIC

UDC HEALTH CLINIC

Questions please contact Katlyn Schwarzwaelder at kschwarzy@aol.com
The Heart Echo's only require the first 6 questions on the dog to be filled in. Please put N/A in the other fields to complete the entry.
Name*

First NameLast Name
Phone Number*
Please list a phone # you can be reached at while at nationals.
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
E-mail*
UDC Membership #
Preferred Test Date"

May 16thMay 17th
1. Registered Name of Dog*
2. Call Name of Dog*
3. Date of Birth- mm/dd/yyyy*
4. Sex of Dog*
5. AKC/Other Reg #
6. Micro Chip #
Country Born:*
Breeders Name*
Kennel Name*
Father's Name*
Father's AKC#*
Father's Kennel Name*
Mothers Name*
Mothers AKC#*
Mothers Kennel Name*
Health Clinic
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HEART ECHO - (UDC Members Only)$150.00

HEART ECHO - (Non UDC Members)$200.00

Holter test$200.00

Total $0.00
HEART ECHO'S CONDITIONS FOR PARTICIPATION: By sumiting this I, voluntarily present my dog, designated above, for evaluation by echocardiography of its current cardiac status. I understand that this evaluation is for screening purposes. I recognize that today’s findings will only reflect my dog’s current cardiac status and do not guarantee the future cardiac health of my dog. I further understand that the echo-sonographer performing today’s evaluation is not a veterinarian and cannot render a diagnosis or prescribe treatment. All echocardiographic values will be reviewed by a Cardiology Diplomat of the American College of Veterinary Internal Medicine and the final results will be mailed after the show. The echo-sonographer however will be sufficiently knowledgeable and experienced as to recognize serious cardiac disease and will advise the owner if a more detailed evaluation is warranted.
I understand that my dog will need to be lifted to a table surface approximately 40 inches from the ground and lay on the right side for the evaluation. I understand that the best ultrasound image quality is obtained with the hair coat clipped away.
Should be Empty:

UDC HEALTH CLINIC

The Heart Echo's only require the first 6 questions on the dog to be filled in. Please put N/A in the other fields to complete the entry.