Is your pet under the care of another veterinarian or health care professional?
- None - Yes No
Is your pet on medications or supplements?
- None - Yes No
What do you feed your pet? *
What treats do you give your pet?
- None - Yes No
Changes in eating/ appetite?
- None - Yes No
Diet change in the past month?
- None - Yes No
Weight change?
- None - Yes No
Changes in drinking/water consumption
- None - Yes No
Changes in urination?
- None - Yes No
Skin changes/itching/rash/lumps?
- None - Yes No
Eyes redness/squinting/discharge/ vision change?
- None - Yes No
Ears/head shaking/scratching/odor?
- None - Yes No
Breathing/coughing/sneezing/gagging?
- None - Yes No
Teeth/gums/breath odor?
- None - Yes No
Legs or back/pain/arthritis?
- None - Yes No
Vomiting?
- None - Yes No
Normal stools?
- None - Yes No
Housebreaking concerns?
- None - Yes No
Spayed or neutered?
- None - Yes No
Changes with reproductive organs?
- None - Yes No
Scooting?
- None - Yes No
Attitude or behavior changes?
- None - Yes No
Other?
- None - Yes No
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