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(503) 650-1667
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418 South Beavercreek Road
Oregon City, OR, 97045
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today:2023-03-29
Skin Pre-Appointment Questionnaire
Please fill out the fields below prior to your pet’s upcoming appointment.
Client Name
*
Pet Name
*
What area of the skin seems to be bothering your pet? How are they reacting? Ex: licking, scratching, biting, or rubbing
What is your pet's itch level?
What do you feed your pet (brand of food or recipe) and how long have they been on that particular diet?
*
What food were they on before the current diet? (Only needed if changes have been made with in the last year)
Does your pet get other treats or food? If so what and how often?
Are there any environmental changes? Ex: new outdoor access or change in soaps/odors etc.
*
Does your pet have a history of these symptoms? Are they reoccurring or seasonal? Has anything helped in the past?
*
When did you last apply flea medication? What was it? Is this new?
Are all other pets in the house on flea medication?
*
Yes
No
Do the ears seem to be affected?
*
Yes
No
Is your pet taking any medications, either prescribed, supplements, or over the counter? If yes, please list
*
Has your pet been prescribed any medications for skin problems in the past? If so, what were they and were they effective?
Do you have any concerns with weight loss or weight gain?
*
Yes
No
Do you need any of the following while you are here for your appointment?
Heartworm Prevention
Flea & Tick Prevention
Refill on Medications
Other
Are there any other details you want to share with us prior to your pet's appointment?
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