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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