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Voor dierenartsen
Verwijzen
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Intake gastrointestinal consultation
Step
1
of
3
33%
What is the name of the owner?
(Required)
What is the name of your pet?
(Required)
What is the date of birth of your pet?
(Required)
DD slash MM slash YYYY
What breed is your pet?
(Required)
When is the appointment scheduled (date and time)?
(Required)
Questions about the nature of the complaints
What is the main complaint of your pet for which you are referred?
(Required)
Since when are these clinical signs present?
(Required)
At what age did these complaints develop for the first time?
(Required)
Does your pet vomit?
(Required)
Maak uw keuze
no
yes
How often does your pet vomit?
(Required)
What does the vomit look like? (digested or undigested food, bile, mucus, blood, darkbrown/black discoloration etc)
(Required)
Does your pet have diarrhea?
(Required)
Maak uw keuze
no
yes
Is the diarrhea continuous or intermittent?
(Required)
Is the diarrhea watery or more mucus like? Is there blood present in the stool?
(Required)
Does your pet show an increased urge to defecate?
(Required)
Maak uw keuze
no
yes
How often a day does your pet produce stool?
(Required)
Does your pet drink more than usual?
(Required)
Maak uw keuze
no
yes
Did you notice any changes to your pet’s appetite?
(Required)
Maak uw keuze
No
decreased appetite
increased appetite
What type of food does your pet eat at the moment?
(Required)
Does your pet eat grass regularly?
(Required)
Maak uw keuze
no
yes
Did your pet get a raw food diet at any point in his/her life?
(Required)
Maak uw keuze
no
yes
Did your pet receive a hypoallergenic diet?
(Required)
Maak uw keuze
no
yes
What type of diet (brand, type)?
(Required)
Did you notice an improvement with the diet?
(Required)
Did your pet get any treats or other extra’s when you fed the hypoallergenic diet?
(Required)
Does your pet have a rumbling stomach/belly that you can hear?
(Required)
Maak uw keuze
yes
no
How is the activity level of your pet?
(Required)
decreased
normal
increased
Is your pet losing weight?
(Required)
Maak uw keuze
no
yes
How many kilo’s did your pet lose, over what period of time?
(Required)
Questions regarding the medications your pet is having.
Is your pet on any medication at the moment?
(Required)
no
yes
What medications does your pet receive? (name + dose)
(Required)
Did your pet get any medication in the past for this problem?
(Required)
no
yes
What medications did your pet receive and what was the effect of these medications?
(Required)
Is your pet on any supplements at the moment?
(Required)
no
yes
Which supplements?
(Required)
When was your pet last treated for worms?
(Required)
What product did you use?
Does your pet have any other clinical signs at the moment?
(Required)
no
yes
What clinical signs?
(Required)
