General Health Form

You can submit a Health Survey by either completing our on-line Health Survey Form below, or by downloading, completing, and mailing the PDF version of the Health Survey Form (PDF).

Please complete this on-line survey for each of your Pyrs and submit it. The information supplied is kept confidential. Personal Information (second section below) will be maintained by an independent tabulator who will assign an I.D. number to each dog. Only the Dog’s Health Information (third section) and the assigned I.D. number will be sent to the health committee for data collection purposes. Before submitting the form you should print it for your records.


By signing below I agree to the following:

  • I understand that the personal information will be held in confidence with the Independent Tabulator for record-keeping purposes only.
  • I understand that the GPCA Health Committee will use the data for the purpose of identifying problems in the breed.
  • I grant permission to the GPCA Health Committee to reprint the data in conjunction with all completed surveys received as a report of summary of the health of the breed.
  • I am the rightful owner or breeder of this dog, and attest that all information provided is accurate and true to the best of my knowledge.

(For purposes of this application, printing your name in the space below constitutes a signature.)

Personal Information

Registry *
Sire's Registry *
Dam's Registry *
Sex of Dog *
Origin of above information *

Dog's Health Information

Is this an update? *
Status *
Is this dog intact? *
Has this dog ever been bred? *
Is this dog deceased? *
Was this dog euthanized? *
Overall health of dog *
Overall temperament of this dog (check all that apply) *

Health History — list only those health problems that were diagnosed by a licensed veterinarian or specialist:

Testing — check only those that apply

You may have to click the SUBMIT BUTTON a second time.

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