PBGV Information Request Form
IF YOU PREFER, YOU CAN COPY THIS FORM TO YOUR BROWSER, AND FILL IT OUT OFF-LINE. SUBMIT YOUR RESPONSES LATER USING YOUR INTERNET E-MAIL UTILITY.
Sysiphus


We are a group of dog owners who are interested in improving the breed by sharing information about our beloved PBGVs. All information is submitted voluntarily. None will be used for any commercial purpose. By submitting information, you certify that the information is correct and truthful to the best of your knowledge. Deliberate submission of misleading or malicious information will result in loss of privileges. The database owners reserve the right to edit or remove incorrect information, and assume no responsibility for the correctness of the information contained therein.
Searchable Database


Links to other sites of interest


Please provide us with the following information. 
Submit a separate form for each dog. Please enter information ONLY for the dogs you own.

If you have many dogs to include, contact us at "email" below for instructions on how to submit the information without filling out a separate file for each dog. I will process it for you.

Background Information

Yourself

Owner's Name (leave blank if you wish to be anonymous) Owner's e-mail address

Your Dog

Registered Name (Required). You can also add call name in parentheses.

Registration Number (optional)
Registered in 
Male  Female

Height  inches  centimeters
Weight  pounds  kilograms
Birth Date (mm/dd/yy)
Death Date (mm/dd/yy)
Orthopedic Foundation for Animals (OFA) Number (optional)
Canine Eye Registry Foundation (CERF) Number (optional)

Sire & Dam Information

Name of Sire (Required)
Registration Number (optional) - Registered in 
Name of Dam (Required)
Registration Number (optional) - Registered in 

Grandparents Information

Name of Sire's Father
Registration Number (optional) - Registered in 
Name of Sire's Mother
Registration Number (optional) - Registered in 
Name of Dam's Father
Registration Number (optional) - Registered in 
Name of Dam's Mother
Registration Number (optional) - Registered in 

If you are willing to share any further information about your PBGV, please fill in the following boxes.

Neck Pain Syndrome  yes  no

Veternarian Diagnosed?  yes  no

By SpinalTap?  yes  no

Short comment, if desired (age evaluated, etc.) 


Hip Dysplasia  yes  no

Veternarian Diagnosed?  yes  no
Hip Condition
Excellent  Good  Fair  Borderline  Mild  Moderate  Severe
Rated By:  Orthopedic Foundation for Animals (OFA)  Penn-Hip


Elbow Dysplasia  yes  no

Veternarian Diagnosed?  yes  no
Elbow Condition
Excellent  Good  Fair  Borderline  Mild  Moderate  Severe
Rated By:  Orthopedic Foundation of America  Penn-Hip 


Other Diseases or Conditions which may be Genetically Transmitted

Allergies  other  Vet Diagnosed? 
yes 
Aseptic Meningitis  Clinical Characteristics
lethargy pain relapses fever agression paralysis blindness responds to corticosteriods
Laboratory Findings
CBC chemistry profile CSF analysis fever myelography
tick serology testing for other infectious disease
Vet Diagnosed? 
yes 
Autoimmune  Endocrine

Blood

Thyroid 
Thyroid Tests performed: 
TT4  TT3  fT4  TSH  T3&T4  autoantibodies  none 
other autoimmune  

Vet Diagnosed? 
yes 
Bones/Joints  Vet Diagnosed? 
yes 
Cancer 
other 
age at diagnosis(year/month) 
organ 
Vet Diagnosed? 
yes 
Ears 
age at diagnosis(year/month) 
other 
Vet Diagnosed? 
yes 
Eyes 
Persistent Pupillary Membranes
Cataracts
age at last exam(year/month) 
Iridocorneal angles
other 
Vet Diagnosed? 
Yes, GP 
Yes 
Opthalmologist 
Heart 
age at diagnosis (IMPORTANT!)(years/months) 
other 
Vet Diagnosed? 
Yes 
Reproductive  MALE

other 
FEMALE

other 
Vet Diagnosed? 
Yes 
Neurologic with Seizures and Hydrocephalus 
age at onset (yr/month) 
frequency (2/month, etc) 
method of diagnosis (EEG,etc) 
other 
Vet Diagnosed? 
Yes 
Skin  condition  Vet Diagnosed? 
Yes 
Teeth  Vet Diagnosed? 
Yes 
Urinary Tract 
Bladder Stones
Vet Diagnosed? 
Yes 
Other  Vet Diagnosed? 
Yes 

Go to top of form

Send us an e-mail pbgvhealth@aol.com



Here are some links to other sites of interest.

Canine Eye Registry Foundation (CERF)
Orthopedic Foundation for Animals (OFA)
NIH Dog Genome Project
Broad Institute Dog Genome Project
American Kennel Club Canine Health Foundation
University of Pennsylvania Hip Improvement Program (Penn-Hip)
Petit Basset Griffon Vendeen Club of America
Veterinary information (medical encyclopedia,etc.)
Petit Basset Griffon Vendeen Club of New York
Basset Griffon Vendeen Club of Great Britain
Danish Kennel Club
Finnish Kennel Club
Club du Griffon Vendeen
Petit Basset Griffon Vendeen Fanciers of Canada
Petit Basset Fanciers of Canada Archives- Health Clearances (OFA & CERF)
Petit Basset Griffon Vendeen Club of Sweden


GO TO TOP OF PAGE