Allergy Questionnaire

Allergies are one of the most common conditions seen by veterinarians. It can be a very frustrating condition for both the pet and pet owner. But, there are many things you can try to help alleviate the symptoms.

Please complete this questionnaire to help us best understand your pet's health needs.


Client Details

GENERAL INFORMATION

Pet was obtained from






Age of pet when obtained





Age of pet when allergy problem started





Frequency of symptoms







Time of day when symptoms are the worst




Location where pet spends most of its time




Areas of your property where the pet has access to












ALLERGY SYMPTOMS

Select the types of symptoms your pet displays


















Please rate the itchiness











Please select the areas affected.

















DIET HISTORY

Select the types of food your pet receives in its diet











MEDICATION HISTORY

Select the types of medications your pet has had in its lifetime











Select the medications that have helped your pet











OTHER CONCERNS

By submitting this form, I acknowledge that I am the owner or agent representing the pet named above and that the information here is true and correct.