University of Missouri Pomeranian Alopecia Survey



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University of Missouri - Pomeranian Alopecia Survey
Registered name ______________________________ Reg#_________

Call name _____________ Birth date __________ Color _________

Male – Female Intact - Spayed/Neutered Age when altered ________
DNA sample sent to University of Missouri study? Yes No not yet
Owner name ____________________________________________

Address________________________________________________

City_________________________ State ______ Zip___________

Phone_______________________ Email ____________________



Please circle the best answer or answers, or fill in the blanks.

Describe the puppy coat:

Amount:

profuse normal sparse can’t remember



Makeup:
topcoat only topcoat & undercoat undercoat only
Texture:
cottony harsh normal thin dry & bristly
Did this dog shed it’s puppy coat? Yes No

If yes, at what age did it drop the puppy coat and grow adult coat?


_____ months can’t remember.
Describe the a

dult coat:

Amount of top coat: profuse normal sparse none

Quality of top coat: harsh soft mixed dry & bristly

Amount of undercoat: profuse normal sparse none


Quality of undercoat: soft too cottony too harsh

Is this dog normally coated today? Yes No



If no, please indicate areas of missing coat on drawings below.







Initial coat loss Maximum coat loss

Did the dog lose enough coat to expose skin? Yes No

Age when coat loss began ________ Age at maximum hair loss ________

Was there a coat color change prior to or during hair loss? Yes No


Following the initial loss, has the lost coat ever regrown? Yes No
If yes, is the new hair normal texture harsher softer
What was the extent of the regrowth? complete partial

Was the regrowth of hair associated with any of the following events?


spay/neuter other surgery illness medication

breeding whelping weaning pups other _______


Is the regrown coat still present? Yes No

If yes, how long? ________ If no, how long until it was lost? _________

Diagnostic tests:

Thyroid: normal hypothyroid hyperthyroid not tested

CBC: normal abnormal not tested

General chemistry panel: normal abnormal not tested

Allergy panel: normal abnormal not tested

Skin parasites: normal abnormal not tested

Other ______________: normal abnormal

Have any treatments been tried to make hair regrow?

Diet change: improvement no improvement not tried

Diet supplements:

improvement no improvement not tried

Topical ointment or cream: improvement no improvement not tried

Shampoos: improvement no improvement not tried
other __________: improvement no improvement not tried
Information on relatives:

Is this dog’s mother normally coated? Yes No Don’t know


Is this dog’s father normally coated? Yes No Don’t know

Are male siblings normally coated? Yes No Don’t know

Are female siblings normally coated? Yes No Don’t know

Has this dog produced offspring? Yes No

If yes, how many litters? _____ Total # Males _____ Females______

Do the offspring have normal coats?

Normal Males______ Males with hair loss __________

Normal Females ______ Females with hair loss ________



Coat status unknown for _______males, _________females

Additional comments (use back of page or attach additional sheets as needed).


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