DogStem survey

Identification

Survey code: EQC-sur2022

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* 1. Dog and owner identification

Dog's name + age in years

Owner's name and surname

Owner's email

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* 2. Name of the veterinary clinic/hospital that administered the treatment

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* 3. Post code of the veterinary clinic

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* 4. Upload a picture of the batch label or type the batch number below (if you have it)

PNG, JPG, JPEG file types only.

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* 5. Type the batch number (if you know it)

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* 6. Administration date

Date

Date

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* 7. Administered joint

Right Hip

Left Hip

Right Elbow

Left Elbow

Other (please specify)

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* 8. Has your dog suffered any adverse reaction such as increase of pain and lameness after DogStem administration?

No

Yes

If yes, please describe: adverse reaction, time to onset, duration and its treatment and did you visit your vet because of the adverse reaction?

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* 9. Has your dog suffered any other adverse reaction after DogStem administration?

No

Yes

If yes, please describe: adverse reaction, time to onset, duration and its treatment and did you visit your vet because of the adverse reaction?

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* 10. I consent to TVM UK/EquiCord contacting me to hear more about my (and my dog’s) experience with DogStem®.

Yes