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Dermatology and Otology research study
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Email
*
Your email
Does your pet have any skin issues similar to the images below?
If so, they may qualify for this study. Please complete the form below and you will be contacted regarding further action.
Your name
*
Your answer
Phone number
*
Your answer
Your dog's name
*
Your answer
Has your pet visited the teaching hospital before?
*
YES
NO
Primary veterinary clinic
*
Your answer
Dog's sex
*
Female
Female spayed
Male
Male neutered
Dog's breed and color(s)
*
Your answer
Dog's age or birthdate (if known)
Your answer
Dog's estimated weight
Your answer
Please describe your dog's temperament.
Your answer
List all medications being administered (including heartworm, flea and tick prevention)
*
Your answer
List any previous or current health concerns.
*
Your answer
Any other questions or concerns
Your answer
Send me a copy of my responses.
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