Dermatological History Intake From
How long has your pet lived in Oregon?
Describe the reason for your dermatology consultation today
Age at which problem first started
Is there any seasonality with the problem(s) described above?
Yes - dermatological issues vary with season
No - dermatological issues do not vary with season
If there is seasonality which season(s) are the worst
Is your pet itchy (scratching, biting chewing, licking)?
If itchy, please note the degree of itch
Extremely severe itching / almost continuous. Itching doesn't stop whatever is happening (needs to be physically restrained from itching)
Severe itching / prolonged episodes. Itching might occur at night and also when eating, playing, exercising or being distracted.
Moderate itching / regular episodes. Itching might occur at night, but not when eating, playing, exercising or being distracted.
Mild itching / a bit more frequent. Wouldn't itch when sleeping, eating, playing, exercising or being distracted.
Very mild itching / only occasional episodes. The dog is slightly more itchy than it was before the skin problem started.
Normal pet. I don't think itching is a problem
If itchy, where is your pet itching?
Other than skin disease does your pet have any other diagnosed medical conditions?
Does your pet have gastrointestinal problems such as diarrhea or vomiting? Please describe
On average how many bowel movements does your pet have per day?
What diagnostic tests have been performed? (skin/ear cytology, biopsy, allergy testing etc...)
What medications is your pet currently taking including flea/heartowm medications?
What supplements is your pet currently taking?
Please check the medications your pet has received for his/her dermatological issue
Antibiotics (ei. Cephalexin)
Antifungals (ei. Ketoconazole)
Steroids (ei. Prednisone)
Antihistamines (ei. Benadryl, Zyrtec)
Allergy shots or drops
Any other medications prescribed including topical medications for his/her dermatological issue?
Please note the response to the above medications - no change/ some improvement/ big improvement
Are there any other pets in the household? And do those pets have skin problems?
Thank you. We look forward to helping your pet!