Health Update Form
Please read CAREFULLY and fill out as much information as possible.
Are
You An IHA Member (*required)
(click one)
Yes
No
If not, please consider joining Here.
link
opens in new window.
Hedgehog
Owner's Information
Owner's
Name: (*required)
Owner's
Address: (*required)
City:(*required)
State/Province:(*required)
Country:(*required)
Postal
Code: (*required)
Owner's
E-mail: (*required)
Owner's
E-mail: (*required)
(please enter again to assure accuracy)
Hedgehog's
Information
If you
are reporting an illness or injury, this is the list of reportable illnesses,
or injuries:
Cancer,
WHS (Wobbly Hedgehog Syndrome), Stroke, FLD (Fatty Liver Disease), Major
Injury, Hereditary Illness, Surgeries, Major Systemic Infection, Reproductive
(breeding related) Illness or Injury.
Hedgehog's
Registered Name:
Registered
Name includes Breeders Herd
Intials
and Hedgehog's IHR Number
EXAMPLE:
DZM Geronimo 96955 A list
of Breeders and Herd Initials can be found Here.
(Link opens in new window.)
Hedgehog's
Condition: (*required)
Type
of Illness/Injury: (*required)
SELECT ONE
If
Cancer,
List
Type and Location: (*required)
If not applicable please enter "NONE"
Duration
of Illness/Injury: (*required)
If deceased, and death not caused by
illness or injury, enter "NONE"
Symptoms
of Illness/Injury: (*required)
If deceased, and death not caused by
illness or injury, enter "NONE"
Treatment
of Illness/Injury: (*required)
If deceased, and death not caused by
illness or injury, enter "NONE"
Date
of Death: (*required)
If not deceased, enter "NONE"
Cause
of Death: (*required)
If not deceased, enter "NONE"
Confirmed
by Necropsy?: (*required)
Please indicate any additional information that would
help
facilitate the registration update in the space below.
Please make sure you have filled out as much
information as possible before submitting this form. If any of the "required" form fields have not been
completed , the submission will be discarded if a valid reason why is not
determined.
