All-breed BAER hearing test questionaire

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Part I: BAER test results. Check apropriate blanks

Left ear	Hearing ___	Deaf ___
Right ear	Hearing ___	Deaf ___

Test performed by ___________________________________

at _______________________________

Age at testing (must be over 5 weeks.) ________

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Part II: Dog information. I will keep this confidential, but I do need a unique identifier and the ability to recognise related dogs in order to answer such questions as whether unilaterally deaf animals are more likely to produce bilaterally deaf animals. Ideal identifier is the dog's registered name.

Breed: ________________________________________

Dog identifier ______________________________________________

Any known relatives tested and their identifiers?

 

 

Base color (ignoring white markings) .___________________________________________________________________________________________________

Pattern of white body markings:

Solid color except for small white markings on chest, toes.	Irish ____ (variable white on neck, legs, tail tip, underbody. No white crossing back between withers and tail base.)	Piebald ____ (White crossing back, large colored spots on body. Some color across back. More than 50% white regardless of position of white, unless color headed white.)
Color headed white ____ (Body predominantly white, with occasional colored spots, most likely near tail base. Predominantly white behind head.)	White with color confined to very small patches	Solid white

Pattern of white head markings (circle best description):

Plain face	Star, snip, or narrow blaze	Wide blaze
Blaze so wide it gives the effect of colored areas surrounding eyes and ears	Half white or all white head, ears retain pigment. Which side?	Half white or all white head, one or both ears white. Which side?

I will be putting in outline drawings on which the boundaries of the dog's white markings can be sketched, so come back in a few days to get them. Print out the questionaire and fill it in. When questionaire is filled out, mail it to:

Sue Ann Bowling
P.O. Box 83962
Fairbanks, Alaska 99708

Genetics Index

sbowling@mosquitonet.com