• Date Format: MM slash DD slash YYYY
  • Check which clinical signs have been present and how severe they have been over the entire course of the pet’s skin or ear problem.

  • How much licking, biting, chewing, scratching, or rubbing does your pet do on the following areas of the body?

  • It is important that we know which types of medications were given to your pet in the past and whether they helped. On the list of medications below, check if they have been given and, if so, how much relief they produced. (Check box “Yes” if given and then how much the treatment helped.)

  • Was it ever given?
  • Was it ever given?
  • Was it ever given?
  • Was it ever given?
  • Was it ever given?
  • Was it ever given?
  • Was it ever given?
  • This field is for validation purposes and should be left unchanged.