booking - IRISH WOLFHOUND HEALTH GROUP

IWHG REGIONAL HEART SCREENING
BOOKING FORM

SESSION

Location:*

Date (dd/mm/yyyy):*

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OWNER(S)

First name(s):*

Surname(s):*

Home tel:

Mobile no:*

Address:*

Email:*

Repeat Email:*

UNLESS YOUR DOG WAS OBTAINED VIA THE IW RESCUE TRUST. YOU MUST PROVIDE ALL THE INFORMATION REQUESTED FOR EACH DOG.

DOG No 1

KC registered name:

KC registration no:

Pet name:

Microchip no:

Date of birth (dd/mm/yyyy):

Dog
Bitch

Subsidy claimed (if applicable):

Seven year old on day of screening, 1st screen in 2024
Superveteran (8 or over on day of screening), 1st screen in 2024
Superveteran (8 or over on day of screening), 2nd screen in 2024
Rescue (via Irish Wolfhound Rescue Trust)

DOG No 2

KC registered name:

KC registration no:

Pet name:

Microchip no:

Date of birth (dd/mm/yyyy):

Dog
Bitch

Subsidy claimed (if applicable):

DOG No 3

KC registered name:

KC registration no:

Pet name:

Microchip no:

Date of birth (dd/mm/yyyy):

Dog
Bitch

Subsidy claimed (if applicable):

DOG No 4

KC registered name:

KC registration no:

Pet name:

Microchip no:

Date of birth (dd/mm/yyyy):

Dog
Bitch

Subsidy claimed (if applicable):

PAYMENT (£100 per hound) IS BY BACS TRANSFER ONLY.

Payment is non-refundable unless the session is overbooked or cancelled.

Fees for hounds rehomed via the Irish Wolfhound Rescue Trust are paid by the IWRT.

Veterans: the Irish Wolfhound Club kindly pays half of the fee for one screen per calendar year for all 7 year olds.

Superveterans: hounds aged 8 + are entitled to one free screen per calendar year provided they are available for research programmes needing their input. The Irish Wolfhound Club kindly pays half of the fee for any second screen per calendar year.

PAYMENT*

I will pay the fee invoiced (if any) on the due date given.

OWNERSHIP*

I am the sole owner or I have the full permission of all the owners in the partnership for the above Irish Wolfhound(s) to undergo heart screening as part of the IWHG Regional Heart Screening Scheme.
I agree

DATA PROTECTION*

To ensure the smooth running of the day, my contact details may be shared with the cardiologist.
I agree

TERMS AND CONDITIONS*

The Regional Heart Screening Programme is run by the Irish Wolfhound Health Group for all Irish Wolfhound owners. Everyone is encouraged to bring their hounds to the sessions for check-ups but we would draw your attention to the following two exceptions:

If your hound is exhibiting any signs of heart disease (see our Guide to Heart Problems for examples of symptoms) or you are at all worried about it, you must take the hound to your own vet as soon as possible; do not wait for an IWHG regional session.

If your hound is already being treated by a referral cardiologist it cannot be seen on this programme without the written consent of that cardiologist and then only for the purposes of a check-up. The IWHG Regional Heart Screening Scheme cannot offer second opinions on diagnoses already made. If you require a second opinion you must request a referral through your own veterinary surgeon.

1. All results are confidential but are sent to Dr Serena Brownlie, the breed's heart research specialist or, with the owner's permission, to the Imperial College London Research Study into Atrial Fibrillation (AF).

2. All cardiologists participating in the scheme are experienced, qualified veterinary cardiologists approved by Dr Brownlie and working to her breed specific measurements.

3. This is a screening service to help anyone wishing to breed from their dog or to check on the current status of their dog. It gives an indication of the state of your dog's heart on the day and does not offer a guarantee that the dog will not develop heart disease at a later stage in its life.

4. A screening session is not a treatment session. Our cardiologists do not carry medications and can only interpret the results they find and advise on further action as required, but not treat at that session.

5. It is recommended that heart screening for Irish Wolfhounds be conducted on an annual basis as a minimum unless otherwise indicated by the cardiologist.

6. Should you have any queries about your hound's screening please contact the IWHG Regional Heart Screening Coordinator immediately. Your case will be referred to the programme's heart research specialist, Dr Brownlie, for assessment and feedback. All queries will be dealt with in the strictest confidence and must be made in writing by the owner of the hound directly to the IWHG and not through a third party or the session host.

7. If you are unable to attend your appointment payment is refundable only in exceptional circumstances and at the discretion of the Irish Wolfhound Health Group committee. Requests for refunds must be made in writing or by e-mail to the Irish Wolfhound Heart Screening Coordinator within one calendar month of the appointment. No refunds will be made beyond one calendar month of the appointment date. A £10 administration fee per appointment is charged, deducted from the initial payment submitted.

8. Neither the Irish Wolfhound Health Group, the session host nor the cardiologist is responsible for any injury or accident sustained by owner/handler(s) or hound(s) whilst on the host's premises.

I agree

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