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DogStem survey
Identification
Survey code: EQC-sur2022
OK
*
1.
Dog and owner identification
(Required.)
Dog's name + age in years
Owner's name and surname
Owner's email
*
2.
Name of the veterinary clinic/hospital that administered the treatment
(Required.)
3.
Post code of the veterinary clinic
4.
Upload a picture of the batch label or type the batch number below (if you have it)
Choose File
No file chosen
5.
Type the batch number (if you know it)
6.
Administration date
Date
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
7.
Administered joint
Right Hip
Left Hip
Right Elbow
Left Elbow
Other (please specify)
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?
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?
10.
I consent to TVM UK/EquiCord contacting me to hear more about my (and my dog’s) experience with DogStem®.
Yes
