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Health Issues

Sharon Myers Health Clearinghouse Form

Date:_____________    Dog's Age:___________    Gender:________

Symptoms:_____________________________________________________

Diagnosis:____________________________________________________

Treatment:____________________________________________________

Outcome:______________________________________________________

Additional Optional Information:

Dog's Name:___________________________________________________

Your Name:____________________________________________________
Would you be willing to talk to other FCRSA members who 

experience a similar health problem with their dog(s)? _______

Send to:

Mary Jo Gallagher
5423 E 38th St N
Wichita KS 67220
Internet: mjgallag@dtc.net
Phone: 316-744-2860


Copyright © 1999, Flat-Coated Retriever Society of America, Inc.
Last Revised: April 17, 1999
Hosted by The American Kennel Club
http://www.akc.org/clubs/fcra/healthform.html