Veterinarian Information Veterinarian Name * Please enter first and last name Clinic Name * Address Line 1 Address Line 2 City State Zip Veterinarian Phone Veterinarian Email Owner Information Owner Name Owner Phone Owner Email * Dog Information Dog Name Breed Age Clinical Questions 1) Does the dog have a solitary brain mass diagnosed by CT or MRI? What is the location and approximate size of the mass? 2) What clinical signs prompted the suspicion of a brain tumor? How have these clinical signs been managed or have they changed? 3) Does the dog have any major systemic disease or other health problem that would preclude general anesthesia and intracranial surgery? If so, what are they? 4) Does the dog have a history of any previous cancers? 5) Does the dog have any current or historical evidence of lymphopenia or immune suppression (other than steroid administration to treat brain edema)?