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Dermatology Admission




Pet Type *
Gender *
4. Is the problem (select one): *
5. Is the problem worse during certain times of the year? *
If yes, when (select all that apply)?
6. Has your pet ever had an ear infection? *
If yes, when (select all that apply)?
7. Is your pet itchy (this includes any licking, chewing, rubbing, biting, or scratching)? *
10. What did you notice first (select one)? *
13. Is your pet primarily (select one): *
14. What flea/tick prevention are you using (list type)? *
15. What heartworm prevention are you using? *
Are the other pets primarily? *
Are the other pets in the household receiving flea/tick prevention? *
18. Do any other pets or people in the household have skin problems? *
20. Does your pet have a sensitive stomach associated with feeding different types of food (ex. vomiting, diarrhea, etc.)? *
22. Does your pet have any travel history (list location)? *