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  • M MN F FN

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  • Generalised Focal Myoclonic
    please cross appropriate box

  • Brief description
  • SEIZURE NUMBER AND FREQUENCY Number of seizures in previous 3 events and date occurred ( dd/ mm/yy ) and/ or frequency (e.g. every 4 weeks)
  • Minutes Hours Days very distressing for owner / dog
  • Pelvic limb ataxia- mild Pelvic limb ataxia- severe Lethargy - mild Lethargy - severe
  • Yes NO
    please attach copies of reports / clinical history

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  • Yes No not performed
  • Anti-epileptic drug history medical history can be attached but please ensure it is clear what the 1) drug dose is (e.g. mg of tablet and number given per day) 2) what drug dose serum concentration relates to.

  • check the medicines from this list and specify below and on the right.
  • Seizures not controlled Unacceptable drug adverse affects
  • The cost of this service is £75 (plus VAT within the European Union) – in the UK the veterinary surgeon is invoiced
    Proposed manner of payment:
  • cheque bank transfer (if outside UK bank fees / commission must be paid by user of service) Paypal (£5 surcharge)
  • If there are any queries then please contact Neurology@goddardvetgroup.co.uk