BMD BLOOD SAMPLE SUBMISSION FORM

Please read the information below and complete this form clearly before taking it with your dog to your vet. If you have more than one BMD please copy this side and fill in one form per sample.

I volunteer this blood sample of my BMD to assist with the DNA study



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Please sign and date

OWNERS DETAILS
Name, Address & Telephone Number or email







DOG’S DETAILS
Kennel or Pedigree Name:

Sex: M / F Age and/or D.O.B. (Month & Year if exact date not known)

Any current Medication ?

Please fill in everything above the line, if you can fill in more details below it will be appreciated but is not essential. You may be briefly contacted (by Steve Green) for more details if necessary. At all times continue on separate sheet if more space is needed.

DOGS BACKGROUND
Please note below any known family history of cancer and if possible specify the type






If possible please also provide pedigree information (parents) if possible about your dog/bitch and, if you know any please, identify any individuals that were diagnosed with cancer, specifying which type as accurately as possible, (records at the vets may be able to help with this). .





This form and the sample should be forwarded to the Animal Health Trust at the address shown overleaf. If you have only included your dog’s name, your form will be copied to Steve Green who will add the necessary pedigree details for the purposes of the project.




Information about the scheme

Please Volunteer YOUR dog
The sample you volunteer will be used in a BMD DNA analysis survey by the Animal Health Trust, with the long-term aim of reducing the incidence of cancer and improving the available treatments. The scheme is backed by all the British BMD clubs and details have been given in club publications. In many, many cases cancer is becoming more and more a treatable condition and the results of this survey will dramatically improve the outlook for Bernese of the future……….. but only with your help.
Requested Veterinary Protocol for sampling.
Please ask your vet to add 5ml of blood to each of 2 EDTA tubes, (these can be provided if necessary). The blood samples should then be posted to the AHT by first class post and the same day if possible. If this is not possible please store the sample in a fridge, NOT freezer, and post as soon as possible.
The address to send samples to is;
Bernese Mountain Dog Project
Oncology Research Department
Animal Health Trust
Lanwades Park,
Kentford,
Newmarket
Suffolk CB8 7UU

This form should accompany the samples.
Information
Further details for owners can obtained from Steve Green by telephone on 0114 2882930 or email , if you discover or remember information about your dog or its relatives and ancestors after this form has gone, this can also be passed on via Steve Green.
Data Protection Statement
Any individual information given on this form will only be used for the purposes of the project by the Animal Health Trust and (sometimes) Steve Green (Bernese Breed Council Health Co-Ordinator) for the purposes of information checking.
Other points
Your vet may only charge a minimal amount for this service if part of a normal consultation. Vets prices for assisting in research can be quite reasonable but some do charge “full” prices, it may be worth “shopping around. This part of the project has to be funded by the owners but we hope that the potential benefits to be gained by this initiative will encourage people to make the effort to contribute. This sample/form does not take the place of a normal biopsy sample.
At certain BMD club events there will be a vet available to take the samples for free, please read the schedules.
Future Follow Up
Whilst it is appreciated that it may be a difficult time for you it would be highly beneficial to the study if you were able to provide a copy of any pathology report regarding any future diagnosis of cancer in this dog/bitch. A second blood sample from your dog would also be of great value. The potential benefits of this project to our own and other breeds and even human cancer research cannot be stressed too highly and this second sample is a vital aspect of the study, please remember the project if you are unfortunate enough to have your dog develop cancer in the future.
Thank you for your interest in our project and be assured that your sample given today will help the Bernese of tomorrow and maybe even your own Bernese in a few years time. If there is a good response the benefits from the survey could come that much quicker and be of help to the dogs taking part in the survey. If you are donating a sample to the survey let people know about it and encourage others. We will never improve things by doing nothing but we will improve the health of Bernese if we all try.