Independent Thyroid Register

Submit Your Story...

As you might have guessed, the Indepedent Thyroid Register really needs your help in submitting case studies.

If you have already filled out the online form for submitting your results to the study, then we ask you to please submit your story of your dog(s). The more information about the various symptoms and treatments for this debilitating condition, the better chance we have of helping others recognise it in their animals.

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

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. All other fields are entirely optional.

If you would like to remain anonymous, please indicate your wishes at the end of your story. We are only interested in the case study, not your personal information.

If you have filled out the results form and you have been issued with a ITR number, please list it in the appropriate field (this is purely for organisation purposes so we can keep your information together).

** 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?

ITR Number: (if applicable)
Name of Malamute:**
Gender of animal:**
Male     Female
Age** (eg, 18 months, 2 years, etc):
Story Submission:**



   
(Please hit Submit button only once.)

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