Owner Name
(Required)
First
Last
Pet Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
When did you first notice your pet's itchiness or skin lesions?
(Required)
MM slash DD slash YYYY
Has your pet experienced any previous skin issues or allergies?
What type of flea, tick, or heartworm prevention is your pet currently using?
Can you describe your pet's current diet? Have there been any recent changes to it?
Are there any signs of itching or skin lesions on yourself or other pets in the household?
Has your pet ever been treated with medications like Apoquel or Cytopoint?
Yes
No
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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