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Skin and Allergy Questionnaire

Owner Information
Owner Name
Does your pet primarily live indoors or outdoors?
Has your pet been to the groomer or boarding recently?
Is your pet on Flea & Tick prevention?
What is your pet's main issue(s) today? Check all that apply
Which seasons are worse for your pet? Check all that apply
Has your pet ever been treated for skin issues or allergies before?
Have there been any changes in your pet's activity &/or energy levels?
Where on your pet’s body did the problem begin? Please check all that apply.
My pet also has some other problems. Please check all that apply.
What does your pet eat?
Treatment History

Please list all medications your pet has been on during the past 12 months (Please also include pet-store bought supplements).
Also, list the duration of each treatment and whether it appeared to help your pet or not.
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