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The Bichon Frise
Club of America (BFCA) offers our sympathy for the loss of your
beloved Bichon Frise. When you feel comfortable enough with your
grief, please complete this report. To assist you with your grieving
process, go to
http://rainbowsbridge.com/Grief_Support_Center/Grief_Support_Home.htm.
This form is
anonymous, and will only be used to keep Bichon Frise owners informed
of current health problems in the breed. Maintaining an accurate
database of the prevalence of diseases in Bichons will be useful in
prioritizing health research funds, and for developing disease
prevention strategies. BFCA greatly appreciates your assistance in
obtaining this data, and thanks you in advance for responding. You
might ask your veterinarian for assistance, who will no doubt
understand the importance of this data for dogs in general, as well as
the Bichon Frise.
Please fill out
the following information and press the “Send it to BFCA Health!”
button. If you would like a response, include your email address in
the beginning. Including your name is optional.
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| Your Name: |
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| Email Address: |
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| Registered Name of Dog: |
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| Registered Name of Sire: |
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| Registered Name of Dam: |
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| Male Female Spayed/Neutered: Yes No |
| Age at time of death Euthanized Yes No |
| Date of Death: |
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If you wish to provide a pedigree or
a copy of the registration papers, that information can be helpful
in research and will be kept confidential by the health committee,
being used only in the event of a professional research project
requiring such information for genetic studies. If you
have any questions or need advice, indicate so in the comment box
and include your email address.
You may add other generations by
listing their registered names in order as they appear on the
pedigree of your dog: (1000 char max)
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| Medical History |
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| What was the cause of death of your Bichon Frise, if known? |
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| Please list any health problems in the past for this dog:
(1000 char max) |
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| Have you previously completed a Health Survey form or Health Incident Form for this Bichon Frise on this web site? |
| Yes No Approximate date submitted |
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| Nutrition |
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| What food were you feeding your Bichon the last few months? |
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| What foods did you feed your Bichon in the last 5 years? |
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| What supplements/vitamins did you give your Bichon? |
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| Any reactions to foods in the past? Yes No |
| Explain:(1000
char max) |
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| Vaccinations and Preventive Medications |
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BFCA
is very concerned about the effect of excessive vaccinations and the
use of preventive medications on the health of the Bichon Frise.
Read the corresponding article on our list of health topics for more
information.
Please provide
the following information for our records, which may have impacted
the diseases your Bichon developed.
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| How often does
your Bichon get vaccinated with core vaccines as a combination shot
(Distemper, Adenovirus or Hepatitis, Parvovirus, Parainfluenza)? |
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| How often vaccinated with: |
| Leptospirosis: |
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| Corona: |
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| Bordetella: |
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| Rabies: |
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| Please type in
the name of any heartworm and/or flea preventive medications you
gave your Bichon in the past. |
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| Comments:(1000
char max) |
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Again, thank
you for your time and interest in providing this information. It
will contribute to a better future for the Bichon Frise. The more
we know, the easier it will be to eliminate existing problems,
prevent early deaths, and possibly offset future health problems.
Please return to the BFCA Health Committee: |
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Ms. Vickie
Halstead, Chairman
5 Oak Ridge Trail
Circle Pines, MN 55014-1755 |
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Please copy the numbers above in the field below before submitting
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