Dog's Registered Name: 

Date of Birth:  (Please use the format "day Month year" - such as 1 Jan 1999)

Gender (male/female; if neutered): 

If Female, date of last season: 

If Neutered, date of operation: 

If Spayed Female, was spay due to pyometra?: 

Height and weight, if known: 

Diet: 

Date of first symptoms: 

Method of diagnosis of osteosarcoma (x-ray, biopsy, etc.): 

Primary tumour location - name of the site where the cancer began: 
If you are uncertain about the name of the bone, click here and another window will open with an annotated skeleton diagram, or ask your veterinarian for the name of the bone.

Site (location) and date of discovery of secondaries, if any: 

Treatment: 

Date of death: 

Vaccination history (dates and type of vaccine if known):

History of other disease and/or injury, if any:

If you own any of the first degree relatives (father, mother, sister, brother, son, daughter), have any of them ever suffered from cardiomyopathy, gastric torsion, osteosarcoma or other cancers?  Please be as specific as possible.

Would you like to add any additional information?

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