Owner Name(Required)
Pet Name(Required)
MM slash DD slash YYYY
Is this a reoccurring problem?
Has your pet been shaking their head or scratching their eyes or ears?
MM slash DD slash YYYY
Have they had a recent bath or been swimming ?
Have you noticed any head tilting or staggering?
Has there been a recent diet or treat change?
MM slash DD slash YYYY

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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