Patella Subluxation Testing Form

Patella Subluxation Testing Form

For Miniature Pinschers over 12 months of age

 

 

Registered Name of Dog: ___________________________________________________________________

 

KC Reg. No. _______________________

 

Sex   _______      Date of Birth    ____________    Microchip/Tattoo  No__________________________

 

Sire ____________________________________________  KC Reg. No. _______________________

 

Dam ___________________________________________   KC Reg. No. ­­______________________

 

Owner’s Name  ___________________________________________________________________________

 

Address  ________________________________________________________________________________

 

 

 

I hereby declare that the dog I have submitted for examination is the one described above.

I agree that the result may be published for Miniature Pinscher Club purposes   –  YES/NO

 

 

Signed  _____________________________________________ Date  ______________________          

 

Veterinary Surgeon’s Declaration

 

I confirm that I have checked the microchip/tattoo number of the dog and the information above with the Kennel Club Registration Document.  At the time of examination I was unable to detect any evidence of surgical interference/intervention in either stifle.  The Miniature Pinscher is over 12 months old.

 

Weight of Dog _________________       Normal/Overweight/Underweight            Neutered:   YES/NO

 

 

The above dog was checked for patella luxation using the Putnam 1968 scoring system as detailed overleaf.

 

 

Score:       LEFT  _______________    (Range 0 – 4)           RIGHT ______________    (Range 0 – 4)

 

 

Any relevant comments ____________________________________________________________________

 

 

Name  __________________________________           Qualifications________________________

 

                                                                                           Year of qualification  ________________________

 

                                                                                           Practice stamp:

 

 

Signature  ____________________________________    Date  _______________________

 

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