2026 Health Clinic Signup Form

2026 Health Clinic Sign Up - PAID

Disclaimer - if, due to human error or shipping complications, any test cannot be run; neither ISCA nor ISCAF is responsible for the resubmission of any sample.

If this happens on a PAID test, a refund of the amount paid for the test will be made.
Tests offered:

CHIC DNA - stored at OFA for future genetic testing and access for veterinary studies

Titers via University of Wisconsin

Thyroid via Michigan State University

The following test are run via PawPrint Genetics. All are included in the Irish Setter panel, or can be ordered as single tests: DM, GLD, CLAD, PRA-rcd1, PRA-rcd4, vWDI

This is the link to the PawPrint Genetics website describing what each test is. Our price at the clinic is absolutely incredible!

https://www.pawprintgenetics.com/products/breeds/125/

Pricing - OFA fees are already included where applicable:

DNA, Thyroid and Titers:

           Free     CHIC DNA
     $ 78.00     Thyroid - For Owner Information - Dog on Meds
     $ 92.00     Thyroid Registry (CHIC)
     $ 60.00     Titers - Regular
     $ 66.00     Titers - Nomograph

For PRA, LOPRA, CLAD and the Panel (from PawPrint):

     $ 50.00 One Test
     $ 85.00 Three Tests
     $ 95.00 Panel (DM, GLD, CLAD, PRA-rcd1, PRA-rcd4, vWDI)

     $   10.00    Microchip

     $   10.00    Handling Fee (1 fee - REQUIRED PER DOG)

If paying by check, mail check to (make check payable to ISCA):

ISCA Health Clinic
150 McFarland Lane
Weatherford, TX 76088

Be sure to mail your check!!! We will not be accepting signups at the clinic!
ITEMS NEEDED (REQUIRED IN SOME CASES) TO COMPLETE

THE HEALTH CLINIC SIGN UP FORMS

These items may require some digging before you are ready to begin
Of course the usual suspects:

Name

Address

Phone

Email

Dog Information:

Registration #

Registered name (NO titles)

Sire’s Registered Name (NO titles)

Sire’s Registration Number

Dam’s Registered Name (NO titles)

Dam’s Registration Number

Veterinarian Information:

Name

Address

Phone

Email

CHIC DNA Test:

You need to know what illnesses or diseases your dog has had

Paw Mark Tests (PRA, etc):

CERF # if you have one

Date of last Exam by ophthalmologist

Results

Titers:

Date of last Vaccination(s)

Brand if known

Thyroid Tests:

Thyroid Medications if on one (dosage and how often given)

Other Medications if on one (dosage and how often given)
PLEASE BE AWARE - Results on these test could take up to 30 days to be received. And even longer for OFA to post the results. In most cases, only one vet reads and interprets all tests we send!!!
YesNo

Health Clinic Information Form

For Payments via Check or Credit Card
YOUR COMPLETED FORMS WILL BE WAITING FOR YOU AT THE NATIONAL. You may print (using your browser's print option) copies of the worksheets you are making now for your own reference. Print each page as you go - before you move to the next page (or chose your next test). You will not have the opportunity to print once you move on. The information you are providing will be loaded into the official forms to be used at the clinic. Type carefully. Double check your work by using the Back Option (at the bottom of each page) if needed. Your work will be saved in your browser as you go along. Once you hit submit you will not be able to make changes. Required fields are marked with a Red *

REMEMBER IF YOUR DOG WAS ACCEPTED INTO THE FREE CLINIC

DO NOT RE-ENTER CHIC DNA OR THYROID ON THIS PAID FORM.

IF YOU DO - IT WILL REMOVE YOU FROM THE FREE CLINIC.
Owner's Name:*
Co-Owner's Name:
Address:*
City:*
State:*
Zip Code:*
Province:
Country:
Phone:*
E-Mail - type carefully (you will receive a receipt at this e-mail address that your forms were received):*
Dog's Registered Name - NO titles please:*
Call Name:*
Date of Birth (mm/dd/yyyy):*
Age (as of the test date):*
Registration Number:*
AKC or CKC?*
Sex:*
ID Number:
Microchip or Tattoo?
Weight:*
Sire's Registration Number:*
Sire's Registered Name - NO titles please:
Dam's Registration Number:*
Dam's Registered Name - NO titles please:
Veterinarian's Name:*
Address:*
City:*
State:*
Zip Code:*
Phone:*
Veterinarian's E-mail:
YesNo
Code that proves BOUGHT Microchip
YesNo

YesNo

YesNo

YesNo

Health Clinic - CHIC DNA Repository
DNA Sample Submission Agreement:

I hereby donate, assign, and transfer a DNA sample of the dog named above to the CHIC DNA Repository for research purposes and warrant my authority to do so. I understand that any future use or distribution of this DNA sample will be within the sole direction and authority of the CHIC DNA Repository. I authorize the OFA and the AKC CHF to provide any researchers receiving a portion of this sample with all necessary information including pedigree and health history to make the sample useful. My intent in providing this DNA sample is to further research into canine health issues. I hereby relinquish all rights to, and ownership of, the DNA sample.
Type your full name below to signify your agreement:*

YesNo

YesNo

YesNo

Health Clinic - Paw Print Genetics Test(s)
Paw Print Genetics will not submit results to third parties. Therefore, to have your results reflected at OFA, you will have to submit them yourself after you receive your results.
rcd1-PRACLADrcd4-PRA (LOPRA)DM (Degenerative Myelopathy)GLD (Globoid Cell Leukodystrophy)vWD1 (Von Willebrand Disease)

Health Clinic - Paw Print Genetics
CERTIFICATION AND SIGNATURES:
By signing this form, I represent and warrant that: (a) all information provided about each dog is truthful and accurate; (b) the sample submitted with this form corresponds to the dog to be tested as indicated by the information provided and found on this form, (c) additional samples may be required to complete the testing and (d) I will cooperate to resolve any disputed results.
Type your full name below to signify acceptance:*

YesNo

YesNo

Health Clinic - Titers

Titers are NOT DONE FOR RABIES!!
Date of Last Vaccination (mm/dd/yyyy):*
BRIEFLY describe health of the dog:*
Is this sample being tested to determine vaccination age for puppies (Nomograph)?*
Expected Whelp Date (mm/dd/yyyy):
Please list if/when your dog received the following: Date (if known)
Combination (CDV, CPV-2, CAV w/wo CPiV)
MonthDayYear
Date
Canine Parvo Virus (CPV-2)
MonthDayYear
Date
Canine Distemper (CPV)
MonthDayYear
Date
Leptospira 4-way (canicola, icterohaemorrhagiae, grippotypphosa, pomona)
MonthDayYear
Date
Canine Corona Virus
MonthDayYear
Date
Rabies
MonthDayYear
Date
Canine Influenza
MonthDayYear
Date
Others
MonthDayYear
Date
Bordetella (kennel cough) *
MonthDayYear
Date
* Was Bordetella Intranasal or injectable?
Serum submissions become the property of CAVIDS Laboratory

YesNo

Health Clinic - Thyroid Test
Brief History:*
Diet Information:*
How long on current diet?
On Medication - OTHER than Thyroid?*
If yes, brief list:
Dosage?
How many hours before blood drawn?
On Thyroid Medication?*
If yes, brief list:
Dosage?
How many hours before blood drawn?
Thyroid - For Owner Information only (and/or the Dog is on Medication)Thyroid - Registry (CHIC)

Health Clinic - Thyroid Information for CHIC
Date of last Routine Vaccination (mm/dd/yyyy):*
I hereby certify that the sample submitted is of the animal described on this application and that this animal has not received thyroid medication of any type for 3 months prior to this test. I understand that only normal results will be released to the public unless the initials of the registered owner appear in the authorization box below which permits the OFA to release abnormal results to the public. Type your full name below to signify your agreement:*
AUTHORIZATION TO RELEASE ABNORMAL RESULTS I hereby authorize OFA to release the results of its evaluation of the animal described on this application to the public if the results are abnormal. Type your full name below to signify your agreement:

CheckCredit Card