Recheck Medical History

Owner's First Name *

Owner's Last Name *

Pet's Name *

The disease of my pet is (please choose one): *

well controlled

not totally controlled, but I do not consider its quality of life is impaired. I do not think that it is necessary to change the treatment.

not totally controlled, but I do not consider its quality of life is impaired and I would like to discuss more interventions for my pet.

not at all controlled. The quality of life of my pet is impaired.

Please provide a brief history of your pet's medical condition since your last appointment. *

Does your pet lick/chew/scratch/rub and where? If yes, how would you rank the severity between 0 and 10 with 10 being the most severe itching that you could imagine? *

Please list the current medications that your pet is taking, as well as the frequency those medications are being given. This includes any topical therapies, prescriptions, supplements, and over-the-counter medications. *

Are there any specific questions or concerns you would like Dr. Webb or Dr. Williams to address? *

Are there any changes of which Dr. Webb or Dr. Williams should be aware? *

Understanding your pet's history is an important factor in treating dermatological disease. Please press the submit button to submit these forms for your appointment. We look forward to meeting you and helping your pet.