{"id":527698,"date":"2025-12-05T08:49:11","date_gmt":"2025-12-05T08:49:11","guid":{"rendered":"https:\/\/veteo.eu\/?page_id=527698"},"modified":"2026-01-14T10:54:05","modified_gmt":"2026-01-14T10:54:05","slug":"myelogram-questionnaire","status":"publish","type":"page","link":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/","title":{"rendered":"Myelogram questionnaire"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row bg_type=&#8221;bg_color&#8221; bg_override=&#8221;full&#8221; css=&#8221;.vc_custom_1761834656474{margin-bottom: 80px !important;padding-top: 40px !important;padding-bottom: 40px !important;background-color: #D63131 !important;}&#8221; bg_color_value=&#8221;#D63131&#8243;][vc_column][vc_column_text css=&#8221;&#8221;]<\/p>\n<h3><span style=\"color: #ffffff;\">Please send 4\u20138 bone marrow smears (or more) as well as the patient\u2019s current complete blood count (CBC) result (performed within the last 48 hours).<\/span><\/h3>\n<h4><span style=\"color: #ffffff;\">The analysis will be performed by dr n. wet. Katarzyna Mr\u00f3z \u2013 we recommend contacting her directly before collecting and shipping the samples: tel. 607945293, mroz.hematology@gmail.com.<\/span><\/h4>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f527582-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"527582\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/527698#wpcf7-f527582-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"527582\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f527582-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/>\n<input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:527582,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;cel-konsultacji-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;cel-konsultacji&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;other&quot;}]},{&quot;then_field&quot;:&quot;objawy-ogolne-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;objawy-ogolne&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;other&quot;}]},{&quot;then_field&quot;:&quot;wezly-chlonne-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;wezly-chlonne&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;wezly-chlonne2-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;rodzaj-wezlow&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;other&quot;}]},{&quot;then_field&quot;:&quot;choroby-zakazne-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;choroby-zakazne&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;choroby-zakazne2-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;rodzaj-choroby-zakaznej&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;other&quot;}]},{&quot;then_field&quot;:&quot;choroby-wektorowe-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;choroby-wektorowe&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;choroby-wektorowe2-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;rodzaj-choroby-wektorowej&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;other&quot;}]},{&quot;then_field&quot;:&quot;choroby-przewlekle-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;choroby-przewlekle&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;choroby-przewlekle2-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;rodzaj-choroby-przewleklej&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;other&quot;}]},{&quot;then_field&quot;:&quot;dodatkowe-informacje1-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;wyjazd-zagraniczny&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;dodatkowe-informacje2-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;szkodliwe-czynniki&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;dodatkowe-informacje3-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;inne-dodatkowe-informacje&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;gatunek-kot&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;gatunek&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;cat&quot;}]},{&quot;then_field&quot;:&quot;gatunek-kot&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;gatunek&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Cat&quot;}]},{&quot;then_field&quot;:&quot;gatunek-kot&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;gatunek&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;CAT&quot;}]},{&quot;then_field&quot;:&quot;gatunek-pies&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;gatunek&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;dog&quot;}]},{&quot;then_field&quot;:&quot;gatunek-pies&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;gatunek&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;DOG&quot;}]},{&quot;then_field&quot;:&quot;gatunek-pies&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;gatunek&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Dog&quot;}]},{&quot;then_field&quot;:&quot;zabiegi-operacyjne-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;zabiegi-operacyjne&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;krewwkale-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;objawy-ogolne&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;diarrhea&quot;}]},{&quot;then_field&quot;:&quot;zmianyskorne-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;objawy-ogolne&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;skin lesions&quot;}]},{&quot;then_field&quot;:&quot;szczepienia-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;szczepienia&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;leki-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;leki&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]},{&quot;then_field&quot;:&quot;badania-obrazowe-g&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;badania-obrazowe&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;yes&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;notice_dismissed_rollback-cf7-6.0.2&quot;:true}}\" \/>\n<input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/div>\n<div class=\"kontener\">\n\t<div class=\"lewa\">\n\t\t<h2>Client information\n\t\t<\/h2>\n\t\t<p><label>Facility name* <span class=\"wpcf7-form-control-wrap\" data-name=\"nazwa-placowki\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nazwa-placowki\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<p><label>Facility address* <span class=\"wpcf7-form-control-wrap\" data-name=\"adres-placowki\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"adres-placowki\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<p><label>Tax Identification Number (NIP)* <span class=\"wpcf7-form-control-wrap\" data-name=\"nip\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-required wpcf7-validates-as-number\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"nip\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<p><label>Veterinarian\u2019s full name* <span class=\"wpcf7-form-control-wrap\" data-name=\"lekarz\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"lekarz\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<p><label>Phone* <span class=\"wpcf7-form-control-wrap\" data-name=\"telefon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telefon\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<p><label>Email* <span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<p><label>Sample collection date* <span class=\"wpcf7-form-control-wrap\" data-name=\"data-pobrania\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" min=\"2019-12-01\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"data-pobrania\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"prawa\">\n\t\t<h2>Basic information\n\t\t<\/h2>\n\t\t<p><label>Owner\u2019s full name* <span class=\"wpcf7-form-control-wrap\" data-name=\"nazwisko-wlasciciela\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nazwisko-wlasciciela\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<p><label>Patient\u2019s name* <span class=\"wpcf7-form-control-wrap\" data-name=\"imie-pacjenta\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"imie-pacjenta\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<p><label>Species* <span class=\"wpcf7-form-control-wrap\" data-name=\"gatunek\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"gatunek\" \/><\/span><\/label>\n\t\t<\/p>\n\t\t<div data-id=\"gatunek-kot\" data-orig_data_id=\"gatunek-kot\"  data-class=\"wpcf7cf_group\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"gatunek-kot2\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"gatunek-kot2\" value=\"outdoor\" \/><span class=\"wpcf7-list-item-label\">outdoor<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"gatunek-kot2\" value=\"indoor\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">indoor<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div data-id=\"gatunek-pies\" data-orig_data_id=\"gatunek-pies\"  data-class=\"wpcf7cf_group\">\n\t\t\t<p><label>Activity*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gatunek-pies2\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"gatunek-pies2\" value=\"low\" \/><span class=\"wpcf7-list-item-label\">low<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"gatunek-pies2\" value=\"average\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">average<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"gatunek-pies2\" value=\"athletic\/working\" \/><span class=\"wpcf7-list-item-label\">athletic\/working<\/span><\/span><\/span><\/span><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"lewa\">\n\t\t\t<p><label>Age* <span class=\"wpcf7-form-control-wrap\" data-name=\"wiek\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required wiekk\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"wiek\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"prawa\">\n\t\t\t<p><label>Breed* <span class=\"wpcf7-form-control-wrap\" data-name=\"rasa\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required rasaa\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"rasa\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"lewa\">\n\t\t\t<p><label>Sex* <span class=\"wpcf7-form-control-wrap\" data-name=\"plec\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"plec\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"male\">male<\/option><option value=\"female\">female<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"prawa\">\n\t\t\t<p><label>Neutering* <span class=\"wpcf7-form-control-wrap\" data-name=\"sterylizacja\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"sterylizacja\"><option value=\"no\">no<\/option><option value=\"yes\">yes<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"nowywiersz\">\n\t<h2>Purpose of consultation\n\t<\/h2>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"cel-konsultacji\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required checkmark\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"cel-konsultacji[]\" value=\"anemia\" \/><span class=\"wpcf7-list-item-label\">anemia<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"cel-konsultacji[]\" value=\"suspected neoplasia\" \/><span class=\"wpcf7-list-item-label\">suspected neoplasia<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"cel-konsultacji[]\" value=\"inflammatory condition\" \/><span class=\"wpcf7-list-item-label\">inflammatory condition<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"cel-konsultacji[]\" value=\"thrombocytopenia\" \/><span class=\"wpcf7-list-item-label\">thrombocytopenia<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"cel-konsultacji[]\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/span><\/span><\/span>\n\t<\/p>\n\t<div data-id=\"cel-konsultacji-g\" data-orig_data_id=\"cel-konsultacji-g\"  data-class=\"wpcf7cf_group\">\n\t\t<p><label>Describe another purpose of the consultation* <span class=\"wpcf7-form-control-wrap\" data-name=\"inny-cel-konsultacji\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"inny-cel-konsultacji\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<h2>General symptoms\n<\/h2>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"objawy-ogolne\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"fever\" \/><span class=\"wpcf7-list-item-label\">fever<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"weakness\" \/><span class=\"wpcf7-list-item-label\">weakness<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"emaciation\/cachexia\" \/><span class=\"wpcf7-list-item-label\">emaciation\/cachexia<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"pale mucous membranes\" \/><span class=\"wpcf7-list-item-label\">pale mucous membranes<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"petechiae\" \/><span class=\"wpcf7-list-item-label\">petechiae<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"diarrhea\" \/><span class=\"wpcf7-list-item-label\">diarrhea<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"vomiting\" \/><span class=\"wpcf7-list-item-label\">vomiting<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"jaundice\" \/><span class=\"wpcf7-list-item-label\">jaundice<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"presence of ectoparasites\" \/><span class=\"wpcf7-list-item-label\">presence of ectoparasites<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"skin lesions\" \/><span class=\"wpcf7-list-item-label\">skin lesions<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"objawy-ogolne[]\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/span><\/span><\/span>\n<\/p>\n<div data-id=\"krewwkale-g\" data-orig_data_id=\"krewwkale-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Suspected presence of blood in the stool? <span class=\"wpcf7-form-control-wrap\" data-name=\"krewwkale\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"krewwkale\"><option value=\"no\">no<\/option><option value=\"yes\">yes<\/option><\/select><\/span><\/label>\n\t<\/p>\n<\/div>\n<div data-id=\"zmianyskorne-g\" data-orig_data_id=\"zmianyskorne-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>What type of skin lesions? <span class=\"wpcf7-form-control-wrap\" data-name=\"zmianyskorne\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"zmianyskorne\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<div data-id=\"objawy-ogolne-g\" data-orig_data_id=\"objawy-ogolne-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Describe other symptoms* <span class=\"wpcf7-form-control-wrap\" data-name=\"inne-objawy\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"inne-objawy\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<p><label>Duration of symptoms* <span class=\"wpcf7-form-control-wrap\" data-name=\"czas-trwania\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"czas-trwania\" \/><\/span><\/label>\n<\/p>\n<p><label>Lymph node enlargement* <span class=\"wpcf7-form-control-wrap\" data-name=\"wezly-chlonne\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"wezly-chlonne\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"wezly-chlonne\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"wezly-chlonne-g\" data-orig_data_id=\"wezly-chlonne-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Indicate the enlarged lymph nodes:* <span class=\"wpcf7-form-control-wrap\" data-name=\"rodzaj-wezlow\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"rodzaj-wezlow[]\" value=\"popliteal\" \/><span class=\"wpcf7-list-item-label\">popliteal<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-wezlow[]\" value=\"submandibular\" \/><span class=\"wpcf7-list-item-label\">submandibular<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-wezlow[]\" value=\"prescapular\" \/><span class=\"wpcf7-list-item-label\">prescapular<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-wezlow[]\" value=\"mesenteric\" \/><span class=\"wpcf7-list-item-label\">mesenteric<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-wezlow[]\" value=\"mediastinal\" \/><span class=\"wpcf7-list-item-label\">mediastinal<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-wezlow[]\" value=\"generalized lymphadenopathy\" \/><span class=\"wpcf7-list-item-label\">generalized lymphadenopathy<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"rodzaj-wezlow[]\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/span><\/span><\/span><\/label>\n\t<\/p>\n\t<div data-id=\"wezly-chlonne2-g\" data-orig_data_id=\"wezly-chlonne2-g\"  data-class=\"wpcf7cf_group\">\n\t\t<p><label>Describe* <span class=\"wpcf7-form-control-wrap\" data-name=\"inne-wezly\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"inne-wezly\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><label>Hepatomegaly* <span class=\"wpcf7-form-control-wrap\" data-name=\"powiekszenie-watroby\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"powiekszenie-watroby\" value=\"not examined\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">not examined<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"powiekszenie-watroby\" value=\"no\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"powiekszenie-watroby\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label><br \/>\n<label>Splenomegaly* <span class=\"wpcf7-form-control-wrap\" data-name=\"powiekszenie-sledziony\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"powiekszenie-sledziony\" value=\"nie badano\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">nie badano<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"powiekszenie-sledziony\" value=\"no\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"powiekszenie-sledziony\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<p><label>Suspected infectious diseases* <span class=\"wpcf7-form-control-wrap\" data-name=\"choroby-zakazne\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"choroby-zakazne\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"choroby-zakazne\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"choroby-zakazne-g\" data-orig_data_id=\"choroby-zakazne-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Which ones?* <span class=\"wpcf7-form-control-wrap\" data-name=\"rodzaj-choroby-zakaznej\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"rodzaj-choroby-zakaznej[]\" value=\"FeLV\" \/><span class=\"wpcf7-list-item-label\">FeLV<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-zakaznej[]\" value=\"FIV\" \/><span class=\"wpcf7-list-item-label\">FIV<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-zakaznej[]\" value=\"FIP\" \/><span class=\"wpcf7-list-item-label\">FIP<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-zakaznej[]\" value=\"panleukopenia\" \/><span class=\"wpcf7-list-item-label\">panleukopenia<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-zakaznej[]\" value=\"distemper\" \/><span class=\"wpcf7-list-item-label\">distemper<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-zakaznej[]\" value=\"leptospirosis\" \/><span class=\"wpcf7-list-item-label\">leptospirosis<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-zakaznej[]\" value=\"bacterial infection\" \/><span class=\"wpcf7-list-item-label\">bacterial infection<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-zakaznej[]\" value=\"fungal infection\" \/><span class=\"wpcf7-list-item-label\">fungal infection<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"rodzaj-choroby-zakaznej[]\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/span><\/span><\/span><\/label>\n\t<\/p>\n\t<div data-id=\"choroby-zakazne2-g\" data-orig_data_id=\"choroby-zakazne2-g\"  data-class=\"wpcf7cf_group\">\n\t\t<p><label>Describe* <span class=\"wpcf7-form-control-wrap\" data-name=\"inne-choroby-zakazne\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"inne-choroby-zakazne\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><label>Suspected vector-borne diseases* <span class=\"wpcf7-form-control-wrap\" data-name=\"choroby-wektorowe\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"choroby-wektorowe\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"choroby-wektorowe\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"choroby-wektorowe-g\" data-orig_data_id=\"choroby-wektorowe-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Which ones?* <span class=\"wpcf7-form-control-wrap\" data-name=\"rodzaj-choroby-wektorowej\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"rodzaj-choroby-wektorowej[]\" value=\"Babesia spp.\" \/><span class=\"wpcf7-list-item-label\">Babesia spp.<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-wektorowej[]\" value=\"Anaplasma spp.\" \/><span class=\"wpcf7-list-item-label\">Anaplasma spp.<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-wektorowej[]\" value=\"Dirofilaria spp.\" \/><span class=\"wpcf7-list-item-label\">Dirofilaria spp.<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-wektorowej[]\" value=\"Mycoplasma haemofelis\/haemocanis\" \/><span class=\"wpcf7-list-item-label\">Mycoplasma haemofelis\/haemocanis<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-wektorowej[]\" value=\"Borrelia spp.\" \/><span class=\"wpcf7-list-item-label\">Borrelia spp.<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-wektorowej[]\" value=\"Leishmania spp.\" \/><span class=\"wpcf7-list-item-label\">Leishmania spp.<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"rodzaj-choroby-wektorowej[]\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/span><\/span><\/span><\/label>\n\t<\/p>\n\t<div data-id=\"choroby-wektorowe2-g\" data-orig_data_id=\"choroby-wektorowe2-g\"  data-class=\"wpcf7cf_group\">\n\t\t<p><label>Describe* <span class=\"wpcf7-form-control-wrap\" data-name=\"inne-choroby-wektorowe\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"inne-choroby-wektorowe\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><label>Chronic diseases* <span class=\"wpcf7-form-control-wrap\" data-name=\"choroby-przewlekle\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"choroby-przewlekle\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"choroby-przewlekle\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"choroby-przewlekle-g\" data-orig_data_id=\"choroby-przewlekle-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Which ones?* <span class=\"wpcf7-form-control-wrap\" data-name=\"rodzaj-choroby-przewleklej\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"renal failure\" \/><span class=\"wpcf7-list-item-label\">renal failure<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"liver failure\" \/><span class=\"wpcf7-list-item-label\">liver failure<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"diabetes mellitus\" \/><span class=\"wpcf7-list-item-label\">diabetes mellitus<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"hypothyroidism\" \/><span class=\"wpcf7-list-item-label\">hypothyroidism<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"hyperthyroidism\" \/><span class=\"wpcf7-list-item-label\">hyperthyroidism<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"Cushing\u2019s disease\" \/><span class=\"wpcf7-list-item-label\">Cushing\u2019s disease<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"Addison\u2019s disease\" \/><span class=\"wpcf7-list-item-label\">Addison\u2019s disease<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"cardiovascular insufficiency\" \/><span class=\"wpcf7-list-item-label\">cardiovascular insufficiency<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"allergy\" \/><span class=\"wpcf7-list-item-label\">allergy<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"rodzaj-choroby-przewleklej[]\" value=\"other\" \/><span class=\"wpcf7-list-item-label\">other<\/span><\/span><\/span><\/span><\/label>\n\t<\/p>\n\t<div data-id=\"choroby-przewlekle2-g\" data-orig_data_id=\"choroby-przewlekle2-g\"  data-class=\"wpcf7cf_group\">\n\t\t<p><label>Describe* <span class=\"wpcf7-form-control-wrap\" data-name=\"inne-choroby-przewlekle\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"inne-choroby-przewlekle\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><label>Findings on imaging studies (X-ray \/ ultrasound \/ MRI) <span class=\"wpcf7-form-control-wrap\" data-name=\"badania-obrazowe\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"badania-obrazowe\" value=\"not examined\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">not examined<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"badania-obrazowe\" value=\"no\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"badania-obrazowe\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"badania-obrazowe-g\" data-orig_data_id=\"badania-obrazowe-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Which ones?* <span class=\"wpcf7-form-control-wrap\" data-name=\"jakie-badania-obrazowe\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"jakie-badania-obrazowe\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<h2>Treatment \/ prophylaxis applied\n<\/h2>\n<p><label>Vaccinations within the last 2 weeks?* <span class=\"wpcf7-form-control-wrap\" data-name=\"szczepienia\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"szczepienia\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"szczepienia\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"szczepienia-g\" data-orig_data_id=\"szczepienia-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Which ones?* <span class=\"wpcf7-form-control-wrap\" data-name=\"jakie-szczepienia\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"jakie-szczepienia\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<p><label>Medications* <span class=\"wpcf7-form-control-wrap\" data-name=\"leki\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"leki\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"leki\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"leki-g\" data-orig_data_id=\"leki-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Which ones?* <span class=\"wpcf7-form-control-wrap\" data-name=\"jakie-leki\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"jakie-leki\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<p><label>Surgical procedures* <span class=\"wpcf7-form-control-wrap\" data-name=\"zabiegi-operacyjne\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"zabiegi-operacyjne\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"zabiegi-operacyjne\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"zabiegi-operacyjne-g\" data-orig_data_id=\"zabiegi-operacyjne-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Which ones?* <span class=\"wpcf7-form-control-wrap\" data-name=\"jakie-zabiegi-operacyjne\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"jakie-zabiegi-operacyjne\" \/><\/span><\/label><br \/>\n<label>Date of procedure* <span class=\"wpcf7-form-control-wrap\" data-name=\"data-zabiegu\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"data-zabiegu\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<h2>Clinical suspicion \/ preliminary diagnosis\n<\/h2>\n<p><label>Describe in detail* <span class=\"wpcf7-form-control-wrap\" data-name=\"wstepne-rozpoznanie\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"wstepne-rozpoznanie\"><\/textarea><\/span><\/label><br \/>\n<label>Previous test results \u2013 provide their reference numbers <span class=\"wpcf7-form-control-wrap\" data-name=\"numery-badan\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"numery-badan\" \/><\/span><\/label>\n<\/p>\n<p><b>Entering the reference numbers of laboratory test results from Veteo constitutes automatic consent for Veteo to disclose these results to dr n. wet. Katarzyna Mr\u00f3z. <\/b>\n<\/p>\n<p><label>Attach files<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"plik\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.png,.pdf,.gif,.jpeg\" aria-invalid=\"false\" type=\"file\" name=\"plik\" \/><\/span> <span class=\"wpcf7-form-control-wrap\" data-name=\"plik2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.png,.pdf,.gif,.jpeg\" aria-invalid=\"false\" type=\"file\" name=\"plik2\" \/><\/span> <span class=\"wpcf7-form-control-wrap\" data-name=\"plik3\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.png,.pdf,.gif,.jpeg\" aria-invalid=\"false\" type=\"file\" name=\"plik3\" \/><\/span> <span class=\"wpcf7-form-control-wrap\" data-name=\"plik4\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.png,.pdf,.gif,.jpeg\" aria-invalid=\"false\" type=\"file\" name=\"plik4\" \/><\/span> <span class=\"wpcf7-form-control-wrap\" data-name=\"plik5\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.png,.pdf,.gif,.jpeg\" aria-invalid=\"false\" type=\"file\" name=\"plik5\" \/><\/span> <span class=\"wpcf7-form-control-wrap\" data-name=\"plik6\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".jpg,.png,.pdf,.gif,.jpeg\" aria-invalid=\"false\" type=\"file\" name=\"plik6\" \/><\/span><\/label>\n<\/p>\n<h2>Additional information\n<\/h2>\n<p><label>Foreign travel in recent years* <span class=\"wpcf7-form-control-wrap\" data-name=\"wyjazd-zagraniczny\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"wyjazd-zagraniczny\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"wyjazd-zagraniczny\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"dodatkowe-informacje1-g\" data-orig_data_id=\"dodatkowe-informacje1-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Country:* <span class=\"wpcf7-form-control-wrap\" data-name=\"jakie-dodatkowe-informacje\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"jakie-dodatkowe-informacje\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<p><label>Harmful environmental factors* <span class=\"wpcf7-form-control-wrap\" data-name=\"szkodliwe-czynniki\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"szkodliwe-czynniki\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"szkodliwe-czynniki\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"dodatkowe-informacje2-g\" data-orig_data_id=\"dodatkowe-informacje2-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>Which harmful environmental factors?* <span class=\"wpcf7-form-control-wrap\" data-name=\"jakie-dodatkowe-informacje2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"jakie-dodatkowe-informacje2\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<p><label>Other* <span class=\"wpcf7-form-control-wrap\" data-name=\"inne-dodatkowe-informacje\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"inne-dodatkowe-informacje\" value=\"no\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">no<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"inne-dodatkowe-informacje\" value=\"yes\" \/><span class=\"wpcf7-list-item-label\">yes<\/span><\/span><\/span><\/span><\/label>\n<\/p>\n<div data-id=\"dodatkowe-informacje3-g\" data-orig_data_id=\"dodatkowe-informacje3-g\"  data-class=\"wpcf7cf_group\">\n\t<p><label>What other additional information?* <span class=\"wpcf7-form-control-wrap\" data-name=\"jakie-dodatkowe-informacje3\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"jakie-dodatkowe-informacje3\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row bg_type=&#8221;bg_color&#8221; bg_override=&#8221;full&#8221; css=&#8221;.vc_custom_1761834656474{margin-bottom: 80px !important;padding-top: 40px !important;padding-bottom: 40px !important;background-color: #D63131 !important;}&#8221; bg_color_value=&#8221;#D63131&#8243;][vc_column][vc_column_text css=&#8221;&#8221;] Please send 4\u20138 bone marrow smears (or more) as well as the patient\u2019s current complete blood count (CBC) result (performed within the last 48 hours). The analysis will be performed by dr n. wet. Katarzyna Mr\u00f3z \u2013 we recommend contacting her&hellip;<\/p>\n","protected":false},"author":8,"featured_media":523868,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-527698","page","type-page","status-publish","has-post-thumbnail","hentry","description-off"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Myelogram questionnaire - veteo.eu - digitales Veterin\u00e4rlabor in Augsburg<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Myelogram questionnaire - veteo.eu - digitales Veterin\u00e4rlabor in Augsburg\" \/>\n<meta property=\"og:description\" content=\"[vc_row bg_type=&#8221;bg_color&#8221; bg_override=&#8221;full&#8221; css=&#8221;.vc_custom_1761834656474{margin-bottom: 80px !important;padding-top: 40px !important;padding-bottom: 40px !important;background-color: #D63131 !important;}&#8221; bg_color_value=&#8221;#D63131&#8243;][vc_column][vc_column_text css=&#8221;&#8221;] Please send 4\u20138 bone marrow smears (or more) as well as the patient\u2019s current complete blood count (CBC) result (performed within the last 48 hours). The analysis will be performed by dr n. wet. Katarzyna Mr\u00f3z \u2013 we recommend contacting her&hellip;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/\" \/>\n<meta property=\"og:site_name\" content=\"veteo.eu - digitales Veterin\u00e4rlabor in Augsburg\" \/>\n<meta property=\"article:modified_time\" content=\"2026-01-14T10:54:05+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/veteo.eu\/wp-content\/uploads\/2024\/12\/haustiere.png\" \/>\n\t<meta property=\"og:image:width\" content=\"940\" \/>\n\t<meta property=\"og:image:height\" content=\"788\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/\",\"url\":\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/\",\"name\":\"Myelogram questionnaire - veteo.eu - digitales Veterin\u00e4rlabor in Augsburg\",\"isPartOf\":{\"@id\":\"https:\/\/veteo.eu\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/veteo.eu\/wp-content\/uploads\/2024\/12\/haustiere.png\",\"datePublished\":\"2025-12-05T08:49:11+00:00\",\"dateModified\":\"2026-01-14T10:54:05+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#primaryimage\",\"url\":\"https:\/\/veteo.eu\/wp-content\/uploads\/2024\/12\/haustiere.png\",\"contentUrl\":\"https:\/\/veteo.eu\/wp-content\/uploads\/2024\/12\/haustiere.png\",\"width\":940,\"height\":788},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Strona g\u0142\u00f3wna\",\"item\":\"https:\/\/veteo.eu\/en\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Myelogram questionnaire\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/veteo.eu\/#website\",\"url\":\"https:\/\/veteo.eu\/\",\"name\":\"veteo.eu - digitales Veterin\u00e4rlabor in Augsburg\",\"description\":\"Digitales Veterin\u00e4rlabor in Augsburg verbindet Innovation mit Erfahrung\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/veteo.eu\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Myelogram questionnaire - veteo.eu - digitales Veterin\u00e4rlabor in Augsburg","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/","og_locale":"en_US","og_type":"article","og_title":"Myelogram questionnaire - veteo.eu - digitales Veterin\u00e4rlabor in Augsburg","og_description":"[vc_row bg_type=&#8221;bg_color&#8221; bg_override=&#8221;full&#8221; css=&#8221;.vc_custom_1761834656474{margin-bottom: 80px !important;padding-top: 40px !important;padding-bottom: 40px !important;background-color: #D63131 !important;}&#8221; bg_color_value=&#8221;#D63131&#8243;][vc_column][vc_column_text css=&#8221;&#8221;] Please send 4\u20138 bone marrow smears (or more) as well as the patient\u2019s current complete blood count (CBC) result (performed within the last 48 hours). The analysis will be performed by dr n. wet. Katarzyna Mr\u00f3z \u2013 we recommend contacting her&hellip;","og_url":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/","og_site_name":"veteo.eu - digitales Veterin\u00e4rlabor in Augsburg","article_modified_time":"2026-01-14T10:54:05+00:00","og_image":[{"width":940,"height":788,"url":"https:\/\/veteo.eu\/wp-content\/uploads\/2024\/12\/haustiere.png","type":"image\/png"}],"twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/","url":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/","name":"Myelogram questionnaire - veteo.eu - digitales Veterin\u00e4rlabor in Augsburg","isPartOf":{"@id":"https:\/\/veteo.eu\/#website"},"primaryImageOfPage":{"@id":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#primaryimage"},"image":{"@id":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#primaryimage"},"thumbnailUrl":"https:\/\/veteo.eu\/wp-content\/uploads\/2024\/12\/haustiere.png","datePublished":"2025-12-05T08:49:11+00:00","dateModified":"2026-01-14T10:54:05+00:00","breadcrumb":{"@id":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/veteo.eu\/en\/myelogram-questionnaire\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#primaryimage","url":"https:\/\/veteo.eu\/wp-content\/uploads\/2024\/12\/haustiere.png","contentUrl":"https:\/\/veteo.eu\/wp-content\/uploads\/2024\/12\/haustiere.png","width":940,"height":788},{"@type":"BreadcrumbList","@id":"https:\/\/veteo.eu\/en\/myelogram-questionnaire\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Strona g\u0142\u00f3wna","item":"https:\/\/veteo.eu\/en\/"},{"@type":"ListItem","position":2,"name":"Myelogram questionnaire"}]},{"@type":"WebSite","@id":"https:\/\/veteo.eu\/#website","url":"https:\/\/veteo.eu\/","name":"veteo.eu - digitales Veterin\u00e4rlabor in Augsburg","description":"Digitales Veterin\u00e4rlabor in Augsburg verbindet Innovation mit Erfahrung","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/veteo.eu\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/veteo.eu\/en\/wp-json\/wp\/v2\/pages\/527698","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/veteo.eu\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/veteo.eu\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/veteo.eu\/en\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/veteo.eu\/en\/wp-json\/wp\/v2\/comments?post=527698"}],"version-history":[{"count":3,"href":"https:\/\/veteo.eu\/en\/wp-json\/wp\/v2\/pages\/527698\/revisions"}],"predecessor-version":[{"id":527702,"href":"https:\/\/veteo.eu\/en\/wp-json\/wp\/v2\/pages\/527698\/revisions\/527702"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/veteo.eu\/en\/wp-json\/wp\/v2\/media\/523868"}],"wp:attachment":[{"href":"https:\/\/veteo.eu\/en\/wp-json\/wp\/v2\/media?parent=527698"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}