Independent Thyroid Register for Alaskan Malamutes.

Submit Your Results...

Independent Thyroid Register - Official Online Form

The following information is required to be included in the study. Please include as much information as you can. To ensure confidentiality, once this form is received, you will be allocated a number (ITR Number) which will be emailed to you. I would suggest that you print a copy for your records and note this number on your copy. Please quote this number if you submit further results for this particular dog.

If you are not sure about any aspect of this form, please forward enquiries to thyroidregister@yahoo.com.au.

You can submit results for all your malamutes. I am looking for normal and abnormal results so please, send them all in.

Please note, no information will be passed on to any other companies and/or individuals, so please rest assured that your details are quite confidential.

All fields marked with "**" are mandatory (write N/A if you do not know or do not have that information yet). All other fields are entirely optional.

** If you live in a country other than Australia, you do not need to fill out any of your address details other than your name, email and country information. Thank you.

Name:**

Street Address:

Suburb:

State:**

Postcode:

Home Phone (inc. area code):

Mobile Phone:

Work (inc. area code):

Email:**

If a country other than Australia:

How did you hear about the Thyroid Register?

Gender of animal:**	Male Female
Age (eg, 18 months, 2 years, etc):**
Age when tested:**
Free T4:**	Reference Range:**
And/OR Total T4:**	Reference Range:**
TSH Assay:**	Reference Range:** (if applicable)
TGAA:**	Reference Range:**
Reason for test:** (eg; breeding, illness. If illness, please give a brief description of symptoms.)
Comments:** (Please include any subsequent testing for this dog such as second T4 or full blood panel to rule out another illness etc.)

Please check that all details marked with "**" are filled out (your name and email are especially important as we need to issue you with your ITR number).

(Please hit Submit button only once.)

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Name:**
Street Address:
Suburb:
State:**
Postcode:
Home Phone (inc. area code):
Mobile Phone:
Work (inc. area code):
Email:**
If a country other than Australia:
How did you hear about the Thyroid Register?