Confirmation

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Select type of submission

Standard
Hip and Elbow Dysplasia scheme

Confirm practice

Jane Smith
Dick White Referrals
Station Farm
London Road
Six Mile Bottom
Cambridgeshire
CB8 0UH

Dog details

Kennel Club Registration number
####
Full name
Fenton Smith
Sex
Male
Breed of Dog
Shih tzu
DOB
DD MMM YYYY
Microchip or Tattoo number
####

Owner details

Owner full name
John Smith
Owner email address
john.smith@email.com

Radiographs

Any optional comments to support the submission

How will the submission will be paid for?