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* 1. Date and time of incident

Please tell us when it happened (if known, or give an approximate date and time if unknown)

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* 2. Location of incident

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* 3. Postcode or town

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* 4. Species involved

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* 5. Breed

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* 6. Animal reference (e.g. your reference number)

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* 7. Body weight (kg)

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* 8. Age of animal

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* 9. Sex of animal

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* 10. What was the animal exposed to?

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* 11. Route of exposure

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* 12. Amount, if known (please include units e.g. mg, ml, tablets, etc)

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* 13. Time from exposure to presentation

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* 14. What clinical signs did the animal develop?

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* 15. What treatments were given and what investigations were performed?

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* 16. Outcome of case

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* 17. Any further comments on the case?

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* 18. Contact for further information, if required (optional).
Thank you for taking the time to complete the questionnaire. We are very grateful for your help.

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