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2003 Health Survey

We are asking everyone that has a Shiloh Shepherd to fill out this survey with as much information as possible.  Our goal is to enter every Shiloh Shepherd into the database.

We need information on every dog out there, not just the ones with diseases, but the healthy ones too!   The more information that we collect, the better the overall picture of our breed will be...

We're also looking for information on previous dogs you may have had.  If you've had Shilohs that have passed on to the Rainbow Bridge, please send us the information about them too, but include a note in question #22 (the comments section) telling us that the dog is deceased, what the cause of death was and the dogs age at the time it passed away.

Our goal is to eradicate genetic diseases from our breed and with your help we can do it!

If you would prefer a copy of the survey that you can print out and mail to us, please click here.

1) Is your dog ISSR Registered?
Yes     No

2) Is your dog a Male or Female?
Male     Female

3) Is your dog Spayed or Neutered?
Yes     No

4) What is your dog's callname?

5) What is your dog's full registered name?

6) What is your dog's registration number?

7) What is your dog's date of birth?
-- mm/dd/yy

8) What kennel did you get your dog from?

9) What is your dog breeder's name?

10) How was your dog identified in the litter or during the LER? (Ex: red collar, green collar, etc.)

11) Does your dog have New Blood?

12) If your dog is the result of another outcross, please provide the breed name, registration information and any other information you think could help.

13) What is the Dam's callname?

14) What is the Dam's full registered name?

15) What is the Sire's callname?

16) What is the Sire's full registered name?

17) If you know it, how many puppies were born in the litter?
Males:      
Females: 

18) What coat color is your dog?

19) What coat type does your dog have?

20) Has your dog been diagnosed with any diseases?

21) If your dog has been diagnosed with any diseases please include the following information here:
  • a) What disease was diagnosed?

  • b) Who diagnosed this disease.

  • c) The diagnostic method if known.  e.g. Bloodwork, Radiographic, ECG, Observation, etc. 

  • d) Was this an acquired or genetic disease?

  • e) The age of the dog at the diagnosis or onset of the disease.

22) If your dog was OFA or PennHIP certified or if you had your own vet read the x-rays, what were the results?
  • Hips:     
  • Elbows: 
  • Dog's age at time of x-ray: 
  • My dog's x-ray was read by:

23) Would you like to provide any additional comments?  
Some things we would be interested in:

Has your dog had other health problems or genetic faults,such as chronic diarrhea, ear infections, carsickness, soft ears, hook tail, etc.

24) Is your dog a known carrier of a disease, even if the dog doesn't have the disease itself?
Please explain:
  • a) My dog has/has not produced the following diseases: (list) when bred to (please name his/her mate).
  • b) In the first litter there were puppies produced (enter total # of puppies) and were affected (enter # of affected puppies).
  1. This breeding was/was not repeated and a total puppies (enter # of puppies)
  • were produced with being effected (enter number of affected puppies.
  • c) My dog was also bred to the following stud/bitch(name)   (date) and a total of puppies were also affected with (enter name of disease).
  • d) All of the above information has been fully documented via individual reports submitted to
the GTF via the survey:  Yes     No

25) Please let us know if this is the first time you've filled out this survey for this particular dog, or if this is an update of information:
First time   Update

26) Please provide us with a way to contact you if we should have any questions about the information you've provided in this survey.  NOTE: If you've filled out surveys for other dogs you don't need to re-type all the information below, just type in your name and in the
Kennel Name area, type "See others".

Owner's Name
Kennel Name
Work Phone
Home Phone
E-mail Address

Do you have any questions?  Would you like someone from the Genetics Task Force Committee to contact you about your dog?
Yes     No


PLEASE NOTE:  
The information collected in this survey is for the good of the Shiloh Shepherd breed.  We appreciate your cooperation
in filling out this survey. We will not sell this list or allow anyone to use it for advertising purposes.


Your dog’s private information will not be accessed by anyone other than ISSR officials who sort the data received
and preparing final statistical reports like the ones already available on our website.


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