Submission Form

Step 1 of 4: Dog Information

Dog Name *

Dog Breed *

-- Breeds -- Affenpinscher Afghan African Boerboel African Wild Dog Airedale Akbash Akita Alapaha Blue Blood Bulldog Alaskan Klee Kai Alaskan Malamute American Bulldog American Eskimo American Hairless Terrier American Indian Dog American Shepherd Miniature American Staffordshire Terrier Anatolian Shepherd Appalachian Greyhound Appenzeller Sennenhund Arubu Canucu Australian Cattle Dog Australian Kelpie Australian Shepherd Australian Terrier Avuvi Azawakh Barbet Basenji Basset Hound Beagle Bearded Collie Beauceron Bedlington Terrier Belgian Laekenois Belgian Malinois Belgian Shepherd-Gronendael Belgian Tervuren Bergamasco Berger Blanc Suisse Berger Blanc Suisse Shepherd Berger Picard Bernese Mountain Dog Bichon Frise Biewer Terrier Black and Tan Coonhound Black Mouth Cur Black Russian Terrier Bloodhound Bluetick Coonhound Border Collie Border Terrier Borzoi Boston Terrier Bouvier des Flandres Boxer Boykin Spaniel Braque Francais Briard Brittany Bull Terrier Bulldog Bullmastiff Cairn Terrier Canaan Dog Cane Corso Cardigan Welsh Corgi Carolina Dog Catahoula Leopard Dog Cavalier King Charles Spaniel Central Asian Shepherd Chesapeake Bay Retriever Chihuahua Chinese Crested Chinook Chow Chow Cirneco dell'Etna Cocker Spaniel Collie Coonhound Coton de Tulear Curly Coated Retriever Czechoslovakian Shepherd Dachshund Dalmation Dandie Dinmont Terrier Danish Swedish Farmdog Decker Terrier Doberman Dogo Argentine Dogue de Bordeaux Doodle-Aussie Doodle-Berner Doodle-Golden Doodle-Labrador Doodle-Old English Doodle-Shelti Dutch Sheepdog Dutch Shepherd English Cocker Spaniel English Coonhound English Mastiff English Setter English Shepherd English Springer Spaniel English Toy Spaniel Equine Estrela Mountain Dog Fiest Fila Brasileiro Finnish Lapphund Flat Coated Retriever Formosan Mountain Dog Fox Terrier Foxhound French Bulldog French Mastiff Friesan Stabyhoun Galgo German Coolie German Pinscher German Shepherd German Shepherd-White German Shorthair Pointer German Wirehaired Pointer Giant Schnauzer Glen of Imaal Terrier Golden Retriever Gordon Setter Great Dane Great Pyrenees Greater Swiss Mountain Dog Greyhound Hanging Tree Cattle Dog Havanese Head Dog Heading Dog Herding-breed mix Himalayan Sheepdog Hound Hovawart Huntaway Husky Ibizan Hound Icelandic Sheepdog Irish Red & White Setter Irish Setter Irish Terrier Irish Water Spaniel Irish Wolfhound Italian Greyhound Italian Sheepdog Italian Spinone Jack Russell Terrier Japanese Chin Karelian Bear Dog Keeshond Kerry Blue Terrier Kooikerhoundje Korean Jindo Kuvaz Labrador Retriever Lagotto Romagnolo Lakeland Terrier Lapponian Herder Leonberger Lhasa Apso Lian Dog Loagotto Romagnolo Longhaired Whippet (Windsprite) Lowchen Lurcher Maltese Manchester Terrier Maremma Sheepdog Mastiff McNab Mi-KI Miniature Australian Shepherd Miniature Bull Terrier Miniature Pincher Miniature Schnauzer Mixed breed Mountain Cur Mucuchies Mudi Native American Indian Dog Neopolitan Mastiff New Zealand Heading Dog Newfoundland Norfolk Terrier Norwegian Buhund Norwegian Elkhound Norwich Terrier Nova Scotia Duck Tolling Retreiver Old English Sheepdog Old Scotch Collie Olde English Bulldogge Papillon Pattersdale Terrier Pekingese Pembroke Welsh Corgi Petit Basset Griffon Vendeen Pharaoh Hound Pit Bull Plott Hound Pointer Polish Lowland Sheepdog Pomeranian Poodle Portugese Sheepdog Portugese Water Dog Potcake Dog Presa Canario Pug Puli Pumi Pyrenean Shepherd Rat Terrier Red Wolf Retriever Rhodesian Ridgeback Rottweiler Saint Bernard Saluki Samoyed Sarplaninac Schapendoes Schipperke Schnauzer Scotch Collie Scottish Deerhound Scottish Terrier Sea Otter Shar Pei Shetland Sheepdog Shiba Inu Shih Tzu Shiloh Shepherd Siberian Husky Silken Windhound Silky Terrier Skye Terrier Small Munsterlander Smooth Fox Terrier Soft-Coated Wheaten Terrier Spinoni Italiano Staffordshire Bull Terrier Standard Manchester Terrier Standard Schnauzer Sussex Spaniel Swedish Vallhund Syrian Tamaskan Dog Texas Blue Lacy Texas Heeler Thai Ridgeback Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Toy Australian Shepherd Toy Fox Terrier Turkish Kangal Dog Vizsla Walker Hound Weimaraner Welsh Corgi Welsh Sheepdog Welsh Springer Spaniel Welsh Terrier West Highland White Terrier Wheaten Terrier Whippet White Shepherd White Swiss Shepherd Wirehaired Dachshund Wirehaired Fox Terrier Wirehaired Pointing Griffon Wirehaired Portuguese Podengo Medio Xoloitzcuintli Yorkshire Terrier

Dog ID Number

Sample Type *

-- Submission Type -- Blood Brush

Is this dog being tested to assess sensitivity to chemotherapy drugs (now or in the future)?
I give permission for VCPL to use my dog's DNA for research (Dogs and Owners will NOT be identified)

Notes about the dog or sample.

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