Canine Epilepsy Network Seizure Survey

Who should complete this survey?

This survey is intended to collect basic clinical data from dogs who have been diagnosed with epilepsy, or who have had seizures but do not have a clear diagnosis at this time.

We would prefer that the dogs reported on in this survey have been or will be participating in the DNA research. This will allow us to use clinical data to assist in locating markers or mutations, leading toward DNA tests for inherited epilepsy.

Instructions and Suggestions for Completing the Survey

The survey will take about 5-15 minutes for most people to complete. It may be useful to review the survey first to see what information will be asked, and gather the records you will need prior to starting the survey. You will be asked for basic information on the dog, contact information for veterinarians or neurologists who have seen this dog, seizure history, testing done, and current treatments.

Use the TAB key to move between the items on the survey. Either type in the requested information or select from the options provided. Pressing ENTER will submit the form so wait until you have completed the form to do so.

When you have completed the survey and hit the "submit" button (or press ENTER), you will see a summary sheet. If you wish to change the answers to any questions, you can use your browser's BACK button (or ALT-Left arrow) to return to the survey. Make any necessary changes and resubmit the edited data.

This survey is intended to gather basic information on this dog's seizures. For ongoing reporting of seizures and medications, please use the Seizure Tracking Log (not online at this time - coming soon!). As with all information collected in the Canine Epilepsy Project, it will be strictly confidential.

CERC Seizure Survey

Ready to complete the survey? Please click the "CERC Seizure Survey" link above, or click here.

If you would prefer to work from a printed version, or want to take it to your vet for assistance in answering the questions, click here for a PDF version of the survey. To open and print Adobe Acrobat PDFs, Adobe's Acrobat Reader browser plugin is required.

Thank you for your time - we do appreciate your participation!