Application for ACC Health Test Certification      Send completed application to  ACC, 3484 Waverley Street, Palo Alto, CA 94306 Kennel Name of Coton_________________________________________________________________ ACC Registration Number___________________ or provide accredited pedigree To be Completed by Veterinarian Please describe the results of your examination for each of the categories. If normal please indicate as N Eyes ___________________________________________________________________________ Hearing ________________________________________________________________________ Heart __________________________________________________________________________ Patellae ________________________________________________________________________ Testes __________________________________________________________________________ Vulva (normal size and opening) ___________________________________________________ Bite ____________________________________________________________________________ All teeth present _________________________________________________________________ Any indication of pain or laxity in hips ______________________________________________ Hair and skin _____________________________________________________________________ Behavior _________________________________________________________________________ Is this dog being treated for any condition? Is there anything else you wish to add? __________________________________________________________________________________ Signature of Examining Veterinarian _______________________________Date __________ Name of Veterinarian___________________________________ Address__________________State___________ZIP__________ Phone Number______________Email Address_________________ There is no charge for HEALTH TEST CERTIFICATION by ACC. If you are a Coton Breeder, you may request a subsequent listing of your name and your dog’s name on the ACC WEB PAGE BREEDER’S REGISTRY. Information supplied by a licensed veterinarian is sufficient for all results except eye tests and thyroid tests. Often a veterinarian can advise you if further testing is desirable. We require a complete standard blood panel.  We recommend but do not require you to have thyroid function evaluated by the Michigan State or equivalent test.  We require the eyes checked by a Board Certified Ophthalmologist. Please send a copy of the test results and a copy of the ophthalmologist's report to ACC. We encourage you to send the eye test results to CERF as well. CERF results are posted on the ACC web site. Comprehensive blood panels are useful in establishing a baseline profile of your dog’s health, but must be seen in the context of overall fitness.  There is no fee for certifying this information and adding it to the ACC HEALTH TEST ARCHIVES. In addition, we will include any orthopedic, heart or thyroid results from OFA, GDC, PenHIP or other examining body to your Coton's certified tests. ACC will register qualified puppies (as determined by the breeder) to be "show/potentially breedable" but will only classify Cotons as "breedable" when the results of all required tests  done at or after one year of age have been received. Signature of Applicant ____________________________Date _________________