If itching, where?
If itching, when?
Do any of the following occur?
Any other signs?
When was this first noticed and what time of the year?
Are the symptoms getting worse?
What aggravates the symptoms?
What helps the symptoms?
Any other illnesses?
What are you feeding your pet?
Did you feed a special diet? if so, please specify
Allergic to drugs, food or medications? if so, please specify
Do you have any other pets?
Do any of these have skin problems? if so, please specify
Do any of the humans in the household have skin problems?
Do any relatives of your pet with skin problems? if so, please specify
Where does this pet sleep?
What do you do for flea control?
Are the other pets treated as well? If so how?
When did you see a flea on your pet last?
How often do you prefer to bath your pet?
Currently on heartworm preventative
What date was the last tablet given and what was the response?
What date was the last injection given and what was the response?
What do you think is the cause of this problem?
Has your pet been receiving Trocoxil (monthly anti-inflammatory tablet)
Should be Empty: