Name *
Name
Please select any of symptoms that your pet is exhibiting CURRENTLY:
Check all that apply.
Please select any of the symptoms that your pet has exhibited in the RECENT PAST:
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Where on the body are any of the above symptoms happening?
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Is this the first time that your pet has experienced these symptoms?
If this is not the first time your pet has experienced these symptoms, at what age did they first occr?
Do the symptoms occur at around the same time each year?
Describe how the symptoms developed
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Do other pets in the household have the same symptoms
My pet
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Please indicate any recent changes in your pet's lifestyle
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Please select any of the following that apply to your pet's diet
Indicate any of the behavioral signs that you are seeing in your pet:
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Please select any treatments that your pet is CURRENTLY recieving *
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Please select any treatments that your pet has been given PREVIOUSLY *