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Email Address
First Name
Last Name
ZIP Code
Dog's Name
Birth Month
Birth Year
Size (Choose One)
1
01
02
03
04
05
06
07
08
09
10
11
12
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Toy <11 lbs/<5 kg
Small 11-22 lbs/5-10 kg
Medium 22-44 lbs/10-20 kg
Large 44-88 lbs/20-40 kg
Giant >88 lbs/>44 kg
Do you currently use Adequan
®
Canine for your dog(s)?
Yes
No
Have you ever used Adequan
®
Canine for your dog(s)?
Yes
No
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