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BRITISH VETERINARY ASSOCIATION/KENNEL CLUB ELBOW DYSPLASIA SCHEME To: British Veterinary Association
7 Mansfield Street, London W1G 9NQ
Telephone: 020 7636 6541
Section A
- 73 0
THE ORIGINAL OF THIS
7
CERTIFICATE IS GOLD
! KC Registered Number Itt ID \.-
-TO BE COMPLETED BY OWNER/AGENT
II
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KC Registered Name ...... .. .~l.~
.......I,. .? ... ~.. !":1. ..c;.u:::. ........ ..\J.:~ . ~ ....... o..~.~L(~ ................................................ ........................... ~
r
Breed .. .....~. :-:§.·..(.7.~ ..~-:7..{.. .. 5i~.1. .... ........ ...... ...... ....
Name of owner ....
Sex ........
~.... <~/. . ~. ~!~:-;,?..~~..s... . . . . . .
r::-............
Date of birth
.t;?.r.L ...~~ ..~ ....I.. 4.-::'??. S
Address ..... .. ,.f. .~ .......~ .v..?:".. 4.<?!;..T(f........~...1:::P............ .
",
... . . . . . . .. . ..S .A...7...~.?:-:-f.~ ..................~ ..~:i~......"'J../!.0...
1..... ....... ,... .. .... .. ...... ...... ... .. ............ ...... ... ......... ........ .......... ... ... . Sire:
c;.
1'r7
Dam:
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C; O~'-
D~./...
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PGD*:
MGS*:
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PGS*:
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MGD*:
I hereby declare that (NB: DELETION OF ANY OF THESE ITEMS INVALIDATES Tl-IIS CERTIFICATE)
(a)
(b)
(c)
(d)
(e) ' These sections are
The particulars above are correct and relate to the dog submitted for radiographic examination not mandatory
This dog is a minimum of one year old and has not previously been graded under this Scheme
I give permission for a copy of the certificate to be sent to the geneticist retained by the breed society or other representative body
I give permission for the results of the examination to be used at a future date for the purpose of statistical research
I give permission for the results to be published and included on the relevant KC documents
Owner'siAgent's signature ........~ ..
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/!.... ~..... ~~ ....~ ............ ...................................................
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Section B ­ TO BE COMPLETED BY SUBMITTING VETERINARY SURGEON
(Section A must be completed in full before completing Section B)
I
Date ... ~..•... .J....
L(......... .I. . :~ :7.....
Microchip/tattoo number
L - ._ _ _ __
_ _ _ __
_
_
_ __
-J
_ _
~.7i ...J(.. . . . .I... ~: ..
I certify that the radiographs relating to the dog Identified above were taken on the following date .......
and In conformIty with the provisions of the Elbow Dysplasia Scheme Procedure Notes
Veterinary surgeon submitting radiographs (BLOCK CAPITALS) ......... ,..... ......... ~......
Address ........~......?>.~.~.~.-:
..... ~. ~ ..S ............~. ~..7:.:-.~~.~..~ .. .. .. ~:... ~~........... ~l
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!.t.sS.....7..~7. ...................................... ,.. ~
.."::....
7..~.~!.. .. .. ......................................,.....
C.................................
~ Y c<.._' ..) ~, ..... ...... .. ... ........ .. ............ M
..... n"L~(""'-tJ
.. .. ... .... .. ...........()C:...... ......................................................... ..... .. . Post code .............
Veterinary Surgeon's Signature .... .... .......... ... .. ......:: ...
~....l _......~............. F/MRCVS
?--.r..... L .tL.........I... n
Date ..
.
Please submit the correct fee for the radiographs to be processed (cheques payable to BVA.) For current fees contact BVA
Section C - TO BE COMPLETED BY SCRUTINEERS
CERTIFICATE OF GRADING
RIGHT
LEFT
GRADE
(range 0-3)
0
OVERALL
GRADE
(max possible 3) 0
[9J
NB The grades are based on a flexed lateral and
neutral lateral view of each elbow and represent the
opinion of the BVA apPOinted scrutineers for the
radiographs submitted. The lower the grade, the fess
eVidence of elbow dysplasia present.
The overall grade given for both elbows is that given to
the elbow with the highest grade. Please consult the
current procedure notes for relevant details (available
from BVA)
WE HEREBY CERTIFY that the grade of the radiographs submitted for the dog Identified above Date .... .. ...
was produced using the grading Criteria of the BVNKennel Club Elbow Dysplasia Scheme
Signed .......
(h~F/MRCVS
~
SIgned ............... ..
2... ..JA.... 20D.8 ........ ~~~ F/MRCVS
11/05