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  • Thurs: 8:00am – 6:30pm
  • Open Saturday Nov. 7th & 21st: 9am - 12pm
  • After Hours Emergencies
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Dermatology Intake Form (Dog & Cat)

Species

Primary Concern

What skin issue(s) are you noticing? (check all that apply)
Is the problem
Is this a seasonal issue?

Affected Areas

Where on your pet’s body are you seeing issues? (check all that apply)

Itching Severity

0 (not itchy) — 10 (extremely itchy)
What behaviors do you notice?

Previous Treatments

Have you tried any treatments? (check all that apply)

Parasite Prevention

Is your pet on flea/tick prevention?

Diet & Environment

Does your pet get people food?
Any recent environmental changes? (new home, bedding, cleaners, etc.)

Other Pets / People

Are there other pets in the home?
Are they experiencing similar symptoms?
Any humans in the household with skin issues?

Medical History

Any known allergies?
Any previous skin issues?
Is your pet having any of the following?
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