BUC

Data of the veterinarian:
Name (*):
Clinic
Address (*):
Phone/Fax:
E-mail (*):
Data of the patient :
Owner's name (*):
Address:
Species (*):	dog cat other
Breed:
Gender:	male castrated male female neuterised female
Age:	Years months
The urolith
occurence	first occurence recurrence , last occurence date diagnosis
method of sample removal	operation chateterisation urohydropulsion spontaneously voided other
source	kidney ureter bladder urethra other