Health update only.
LPN2 result request. You will be invoiced $40 per dog. Payment is required before results will be released.
Polyneuropathy affected dogs submitted to the University of Minnesota may be elidigible to receive LPN2results at no cost with pre-approval.
E-mail firstname.lastname@example.org for more information.
Registered Name:Call Name:
Registration number:Birth Date (mm/dd/yyyy):
Date of Death (mm/dd/yyyy):
Sire:Dam:Sex:Male Female Intact Neutered/Spayed
Has this dog been diagnosed as being affected with polyneuropathyand/or laryngeal paralysis. If yes, indicate how and by whom (biopsy, EMG,nerve conduction study, laryngeal scoping, etc). If available, please attach a copyof the test results to the reply email you will recieve upon completion of this form.Yes: No:
Knuckling/Dragging toes:Yes: No:Age first noticed:Stumbling:Yes: No:Age first noticed:High-stepping gait:Yes: No:Age first noticed:Hitched gait:Yes: No:Age first noticed:Exaggerated stomping of the rear limbs:Yes: No:Age first noticed:Muscle atrophyYes: No:Age first noticed:If yes, which limbs were involved?Front RightFront LeftRear RightRear LeftFeel free to elaborate on your answers to the above questions:
Spinal Disc Disease
Torn Cruciate Ligament
Would you like us to share your dog's DNA with the Broad Institute Cancer Study?They need both affected and normal older dogs.
Please elaborate on any checked items (age diagnosed, method of diagnosis, interventions taken, level of control achieved, etc.)Does your dog have any other medical conditions or additional signs?If deceased, please state the cause or circumstances of death.
I am willing to provide additional blood or cheek swab samples if needed for research.Yes: No:I am willing to consider donation of a nerve/muscle biopsy sample upon the death of thisdog, and I will discuss this decision with my veterinarian so that a notation isplaced in the file.Yes: No:
This survey is for the purpose of Leonberger genetic health research; if necessary we may contact you for a phone interview or follow-up questionnaire. We may contact your veterinarianfor additional health information or to obtain a copy of test results mentioned above. The identity of dogs and owners participating in this research will not be revealed.
I have supplied complete and accurate information, to the best of my knowledge.Electronic Signature: Date:
Would you like us to register your dog's LPN2 test result with OFA at no charge (this will occur at the end of Septemeber)?
Yes, please upload LPN2 clear results.
No thank you.
* LPN2 affected results can be recorded with OFA at no charge with a signed release sent directly to OFA.
· If you send LPN2 clear results to OFA on your own, you will be charged the normal listing fee of $15.
· Your dog must already have an entry with OFA (hips, eyes, LPN1, etc) for the LPN2 result to upload into OFA’s database at no charge. This is OFA's rule not the University of Minnesota's.
· LPN2 affected results can be registered with OFA at no charge at any time by: blacking out the LPN1 result (so you are not billed for the LPN1 listing), signing the result report, and mailing directly to OFA. OFA requires a signed release form to post non-clear results.
· If you have not submitted your LPN1 test result to OFA yet, you can register both LPN1 and LPN2 for the single listing fee of $15 if they are sent in at the same time.
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