• Dermatological Exam - Virtual Check-In

    Hello!  Please help us expedite your check-in process, decrease your wait time, duplication of services and increase our capacity to troubleshoot your pet's dermatological problem, and offer you the best skin care, by completing this history form prior to your appointment.  You can complete it by yourself, with other family members or in the office, but with a little advance planning we can help lead your attending DVM to develop the best plan for your pet's ongoing healthcare.
  • Appt Date If Known
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  • GENERAL INFORMATION

  • Patient Species*
  • Pet's Biological Gender & Reproductive Status*
  • Lifestyle*
  • Canine Activities or Occupation

  • Feline Activities or Occupation
  • Lifestyle III - Water Borne Illness/Injury
  • Lifestyle II - Housemates and Animal Neighbors*

  • Resources

  • Medication I*
  • Medication III
  • Vitamins, Supplements, Over-the-Counter Remedies or Medications*
  • My Dog's External Parasite Prevention (Flea/Tick Etc) of Choice is:*

  • My Cat's Parasite Prevention (Flea/Tick, Heartworm, Ear Mites Etc) of Choice is:*

  • External Parasite Prevention - Housemates - Which Pets Are Treated?*
  • Resources - Food & Water Vessels - Cat

  • Health History and Dermatological Condition

  • Allergy History If any as Diagnosed by a Veterinarian - Select all that apply*

  • Vomiting?*
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  • What area of your pet's body are involved in this dermatological event? Please select al that apply today.*

  • Ear Condition - Please Select all that apply
  • Any New or Chronic Hair Loss Noted? Please select al that apply today.*

  • Any Dandruff Present?*
  • Signs of Problem Is Worse*

  • Seasonal Patterns: f your pet has had this problem, or related skin problems, please state whether you've notice it
  • Pet's Most Recent Medications or Treatments - Select all that apply

  • Oncology Screen
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  • Parasite Screen - I have noticed the following within the two months:*

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  • Regarding Your Pet's Bowel Movements*
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  • Patient Behavior & Finish

    Sometimes changes in a pet's behavior can indicate pain, illness, or injury. We have just a few more questions to ensure that we have as much information we can use to help your pet. Remember they can't speak and tell us what's wrong, so we count on you and thank you for your patience!
  • Behavioral Screen*

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