Owner's Name
(Required)
First
Last
Pet's Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
When did you first notice the coughing?
(Required)
MM slash DD slash YYYY
How often does the coughing occur, and is there a specific time of day when it is more frequent?
Can you describe the sound of the cough? Is it dry, wet, honking, or something else?
Has your dog experienced any recent changes in behavior or activity levels?
Has there been any recent exposure to other animals, particularly those with respiratory issues?
(Required)
Yes
No
Is your dog currently on any medications or supplements?
(Required)
Yes
No
Which one?
Are there any other symptoms present, such as sneezing, nasal discharge, or difficulty breathing?
What is your dog’s current diet, and have there been any changes recently?
Has your dog had any previous respiratory issues or other health problems?
Yes
No
Have you noticed any changes in your dog's environment, such as new cleaning products, smoke, or allergens?
Yes
No
Which?
Please send all previous records to us as soon as possible or list previous vet and we will reach out on your behalf to get them.
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