CTCA Health Test Form

DATE of Exam: __________________

Official Name of Dog:

_______________________________

CTCA Registration Number: ________

BLOOD CHEMISTRY, Form 3 of 3

July 8th, 2010

<Click Here to return to the Code of Ethics>


The CTCA requires a general, comprehensive blood panel and several additional serum panels to complete this portion of the CTCA Health Test. The general, comprehensive blood panel should test for:

Glucose

Urea Nitrogen

Creatine

Alkaline Phosphatase

Total Protein

Albumin

Bilirubin (total)

ALT (SGPT)

AST (SGOT)

Cholesterol

Calcium

Phosphorus

Sodium

Potassium

Chloride

A/G

Bun/Creatinine

Globulin

Hemoglobin

Hematocrit

WBC

RBC

MCV

MCH

MCHC

Platelet Est

Absolute Polys

Absolute Bands

Absolute Lymphs

Absolute Monos

Absolute EOS

Absolute Basos

 

We require the following additional panels/test:

In your opinion, are there any symptoms exhibited by this dog that would suggest the need for additional tests? If so, please specify:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Please attach the lab results (fax or print out) to this form. The results should clearly show the name of the dog and the date. If not visible, please write on the form and sign.

Thank you again!

TO THE APPLICANT: Any falsification of these tests may result in your immediate and permanent expulsion from the CTCA, the reclassification of your dogs or possibly the removal of your dogs and their progeny from the CTCA's database.