Name* First Last What are your health concerns for your pet today?*How long has your pet had these health concerns?*Have there been any changes to your pet's appetite?Have there been any changes to your pet's activity level?Has your pet been experiencing any vomiting, diarrhea, coughing, and/or sneezing? If so, which?Is your pet currently on any medications?Do you need refills on any of your pet’s medication today?*YesNoThis scale is designed to measure the severity of itching in dogs. Itching can include scratching, biting, licking, chewing, nibbling and rubbing. Please read all the descriptions below, starting at the bottom. Then, please indicate the number in the field below best describing the severity of itching Severity of Itching*Please enter a number from 0 to 10.
