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When to Spay or Neuter Your Dog
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Healthy Pets, Newsletter From AAHA
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Before You Get A Pet
Almaguin All Animal Rescue
Preventive Health Care
Helpful Information About Your Cat
Problem Solving for Cat Pet Owners
Feline House Soiling
Life Stressors for Cats
Bottle Feeding an Orphaned Kitten
Helpful Information About Your Dog
Normal Birth in Dogs
Diabetes, How To Use The VetPen
Bandage and Splint Care in Dogs
How to Trim Your Pet's Nails
Pet Insurance and Financial Assistance
The Loss of a Pet
The Rainbow Bridge
10 Ways to Help Children With Petloss
Helping a pet Grieve for a "Buddy"
Info Graphics & Fun Facts
Owner and Pet Information
Pet D.O.B. / Age
SECTION 1: Is itching the reason for the consultation?
1.1 Check all that apply
Belly / stomach
Sides / flanks
1.3 If your pet's itching seems to get worse sometimes, please check all that apply.
Mainly in the Spring
Mainly in the Summer
Mainly in the Fall
Mainly in the Winter
In the morning
In the house
Outside, in contact with vegitation (mowed grass, trees, weeds, plants).
After medication ---> please specify
After this situation or event ---> please specify
1.2 Which of the following statements best describes the seasonality of itching or ear problems in your pet over the last 12 months?
I cannot answer this question because the problems have been going on for less than a year.
My pet itches the same all year round (absolutely no increase in itch in winter compared to warm weather months). This was true from the onset.
My pet used to have a warm weather seasonal itch that has evolved into a year-round itch gradually over time.
My pet itches all year round but itching increases noticeably in the winter (especially when the forced air heating is turned on).
My pet itches all year round but itching noticeably increases in the warm weather months when the pollens are out.
My pet does not itch at all in the winter, but itching occurs in the warm weather months when the pollens are out.
I'm not sure
1.3 After what medication?
1.3 After what situation or event?
SECTION 2: Are there any problems other than itching?
2.1 Please check any of the following problems that pertain to your pet.
Red bumps (papules)
Smelly ears (otitis)
Flaky, dry skin (dandruff)
Oily, greasy skin
Hair loss (alopecia)
Red skin (erythema)
Thick skin (elephant skin)
Change in stool consistency
Gas / flatulence
Scooting (rubbing bum on floor)
Tiredness / lethargic behaviour
2.1 Other, please specify
2.2 How many bowel movements does your pet have per day
SECTION 3: How long have the problems been present?
Please note in weeks, months or years
SECTION 4: Origin, travel history, environment, other animals,
people in your household, grooming.
4.1 How old was your pet when you adopted/obtained him/her?
4.2 Where was your pet adopted/obtained
was it from the pet store, a private breeder, a kennel, SPCA, etc.
4.3 Has your pet ever traveled outside of Ontario? If yes, when and where?
4.4 Has your pet been out of his/her usual environment recently?
For example: vacation, play-date, play-care, visit to family or friends, kennel, pet-sitter, etc.
4.5 Please check any of the following that are present in your pet's environment
Feather blanket(s), duvet(s)
Forced air heating
Swimming in lake
Swimming in river
4.6 Do you have any other animals? If yes, details:
4.7 Do any of your other pets have skin problems?
4.8 Do any people in your house have skin problems?
4.9 Do you (or someone else) bathe/groom your pet at home? If yes, frequency and products:
SECTION 5: Diet history
5.1 What does your pet eat? Please tell us brands and check the labels for main ingredients (i.e. chicken, beef, lamb, rice, corn, wheat, etc.)
5.2 When did you start feeding the current diet? Please specify in duration on weeks, months, years
Other (i.e. supplements):
5.3 Have hypoallergenic diets been tried?
Yes, and it helped with the skin problems
Yes, but it did not help with the skin problems
Yes, and it helped with the gastrointestinal problems.
SECTION 6: Other illnesses, current and previous treatments
6.1 Does your pet have any other illnesses?
Yes, now. Please give details below
Yes, in the past. Please give details below.
I'm not sure
Details on pet's other illnesses
6.2 List any medications your pet is currently taking. Include all treatments that are over-the-counter
Example: oral medication, shampoo, ear drops, thyroid medication, heart medication, etc.
6.3 Does your pet have any known adverse/allergic reactions to medications? If yes, please provide details.
For example: antibiotics, anesthesia, sedation, vaccinations, shampoos, ear cleansers, ear drops, etc.
6.4 Please check any of the following statements that pertain to the use of medications for skin
There were so many that I can't remember.
The itch goes away completely as long as my pet gets steroids (i.e. Vanectyl-P, Prednisone, prednisolone).
The itch is partially controlled as long as my pet gets antihistamines (i.e. Benadryl, Reactine)
The rashes go away completely with antibiotiocs but keep coming back.
I tried cyclosporine (Atopica).
I tried allergy shots.
I have tried everything and nothing works.
SECTION 7: Flea exposure and flea control
7.1 Does your pet have fleas?
Yes, right now. Please provide details below.
I'm not sure.
Yes, in the past. Please provide details.
Details if your pet has fleas.
7.2 Do you use flea control products on your pet?
Yes. Please provide product information below
If yes, which product?
SECTION 8: Additional history
Please provide details of any other information that you feel may be helpful (i.e. pet's temperament, special requests/concerns, your expectations as the pet's owner, etc.)
Do you already have an appointment? when?
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