Comments

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What skin or ear problem are you bringing your pet in for?

How long has the problem been present?

How old was your pet when the problem first started?

When the problem started, did it come on suddenly or gradually over a period of time?

What did the skin or ear problem look like initially?

How has it changed or spread?

The problem has been (check one):

Continual, even with medication

Continual but better with medication

Intermittent or sporadic

Is the problem worse during certain times of the year? If so, when?

Over the past year, how itchy has your pet been during a typical outbreak of skin or ear disease? Use a scale of 1 to 10 with 1 meaning an occasional scratch, like a normal person or animal might do, and 10 meaning constant, severe scratching.

Using the same 1 to 10 scale, how itchy has your pet been over the past month?

Is your pet receiving any treatment now? If yes, what kind?

When did your pet last receive any medication, and what medication was it?

What do you feed your pet now?

Have any different diets been tried as treatment? If so, list the brand name and for how long you fed it:

How often do you usually bathe your pet? With what?

When was the last time you saw a flea on your pet or another pet in the household?

Do you routinely use flea or tick preventive products on your pet (list type)?

How old was your pet when you obtained him/her? Where did you get your pet?

What other pets are in the household?

Do any of the other pets have skin problems? Do any people in the household have skin problems?

What percentage of the day and night does your pet spend indoors vs. outdoors?

Other than skin disease, does you pet have any diagnosed medical problems?

Please list any other clinical signs your pet has that have not been described above or anything else you suspect might be contributing to your pet’s skin or ear disease?