Last Name*
First Name*
Phone Number*
Email*
Pet Name*
Your Pet's Breed*
Pet Birthdate*
Pet Sex*
When did you acquire your pet?
Where did you acquire your pet?
Do you have pet insurance?
Does your insurance cover allergies/skin conditions?
What is your most important concern?*
When did the problem start?*
What was the first symptom and how did it start?*
Is there a time of the year when the problem is worse?
Has your pet ever had a severe allergic reaction?
Has your pet had an ear infection?
If yes to ear infections, how many and how often are the ear infections?
Does your pet focus on any of the following issues?
Which parts of its body does your pet focus on?
What is your pet's current itch score?
Current Medications: names, doses and frequency. Length of prescription. Any other details.
Past Medications: names, doses and frequency. Length of prescription. Any other details.
Fecal Score*
Frequency/number per day?
What is your pet currently eating? Include treats, human food, and / or supplements.
What other diets have you tried in the past and what changes were noted with these diets?
Can you give your pet oral medications?
Can you bathe your pet?
How often do you bathe your pet and what type of shampoo do you use?
Can you give your pet ear medication?
Are there any other animals in the home?
If there are other pets in the home, what type are they and do they have any skin, allergy and/or ear conditions?
Does your pet have any other illness or conditions?
List of all known vets prior to visit.
What are your goals for your upcoming appointment?
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Very hard and dry, often expelled as individual pellets so requires much effort to expel from the body and leaves no residue when picked up.
Ideal scoreFirm but not hard, segmented in appearance with little to no residue on the ground when picked up.
Log-shaped with little or no visible segmentation, moist on the surface leaving residue on the ground but generally holds form when picked up.
Very moist and soggy, log-shaped with no segmentation, leaving residue on the ground and losing form when picking up.
Has texture but no defined shape. Presents as piles or spots and leaves residue when picked up.
Watery, has no texture and appears as flat puddles.