Animal Doctor Westside Your Other Family Doctor SKIN First name * Last name * Preferred contact number. * Patient name * NEW PATIENTS ONLY: How long have you had the patient? NEW PATIENTS ONLY: Where did you get him/her? NEW PATIENTS ONLY: Is the patient microchipped? Yes No Unsure NEW PATIENTS ONLY: Vaccination history (be specific) NEW PATIENTS ONLY: Does the patient have any underlying conditions? Yes No Unsure NEW PATIENTS ONLY: If yes, please explain. Where is the lesion/mass and when did you first notice it? * Describe changes you have noticed over time. * Is this a reoccurring problem? * Yes No Unsure If reoccurring, are the flare-ups during a specific season? Which season? If reoccurring, which areas are affected? If reoccurring, has anything worked in the past? Is your pet experiencing (check all that apply): * Licking Chewing Coughing Sneezing Vomiting Diarrhea Lethargic Issues with ears None of the above How itchy is your pet on a scale of 1-10? (1=not itchy, 10=up all night scratching) * Has the mass/lesion ever been evaluated? If so, was any testing performed? * Briefly describe your pet's thirst, appetite, and urination. * What kind of food are you feeding? How much per day? Table scraps/ treats? Have you ever tried a special food? * Have you changed foods and/or treats recently? * Yes No Unsure Has your pet been in contact with other animals? * Yes No Unsure CATS ONLY: How often does your cat go outside? Does he/ she go outside on a leash or on a screened in porch? Have you tried anything at home? Please explain if yes. * Is the patient on any medications? Include dosage and frequency. * Are you administering flea/ tick preventative? What type and how often? * Are you administering heartworm preventative? What type and how often? * Do you have any additional questions or concerns you would like to address with the Doctor today? * Submit If you are human, leave this field blank.