Itchy Dog Evaluation Form


A through historty help us find the source of your dog's itching more quickly.

Please answer the following question guide the diagnostic process.

 
1 Start 2 Complete
Physical Evaluation
Please check any that describe your dog and circle problem areas on the drawing.
Severity Evaluation
On a scale of 0 to 10 rank the severity of your dog's symptoms.
Onset and Seasonality Evaluation
Parasite Control
Lifestyle Evaluation
Dietary Evaluation
Relationship and Behavioral Evaluation
Indicate if and how your dog's itching has affected his or her behavior and relationship with you (Circle all appropriate answer)
Prior Treatments
Next Steps

Physical Exam:

A Thorough physical evaluation of your dog will help us identify obvious problem and conditions such as parasites.

Laboratory Testing:

Ear Swab- to identify any infections in the ear including yeast and/or bacteria

Skin Scrape/ Hair Pluck- to detect scabies or dermodex mites

Impression Smear/Tape Prep- to detect other parasites and check for presence of yeast and/or bacteria