Animal Care Clinic - Allergy-Skin Prelim Questions

1
Client Information* This field is required.
Owner's Name
Home Phone
Mobile Phone
Email
2
Please take a Pruritic itch scale along with this page.
3
* This field is required.
What type of food does the patient eat?
Any treats, people food?
Is this an issue at a certain time of the year?
Please Select
Please Select
Indoor
Outdoor
Indoor/outdoor?
How much time outside/inside?
4
Itch/scratch/lick pattern - face, ears, feet, back, tail, belly?* This field is required.
5
Have owners seen fleas? Using any preventatives? If so, what kind and when/how often.* This field is required.
6
Any sores / scabs / bumps / hotspots?* This field is required.
7
Does the skin have an odor or any discharge?* This field is required.
8
How is patient’s activity level, appetite, or any c/s/v/d? (If yes to c/s/v/d, how often and when did it start?)
9
Any new blankets / bedding / detergent / or other environment changes?
10
Other info
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: