Dermatologie Questionnaire Ear Cat - Medisch Centrum Voor Dieren

Dermatologie Questionnaire Ear Cat

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Name owner(Vereist)

Cat’s name(Vereist)

date of birth(Vereist)

Breed(Vereist)

Questions about the nature of the complaints

Your cat has complaints of(Vereist)

Since when has your cat been showing these problems/complaints?(Vereist)

How old was your cat when these complaints started?(Vereist)

Do you have other pets?(Vereist)

What other pets do you have?(Vereist)

Does your cat vomit sometimes?(Vereist)

Does your cat have other (physical) complaints, except ear complaints?(Vereist)

yes my cat has other physical problems(Vereist)

What medications did your cat get for the ear complaints and can you indicate the effect of this?

Name From and until when given Effect

Please, try to be a detailed as possible, meaning; when, for how long and how mane tablets etc. The veterinarian’s referral letter might help.

Medication 2

Name From and until when given Effect

Please, try to be a detailed as possible, meaning; when, for how long and how mane tablets etc. The veterinarian’s referral letter might help.

Medication 3

Name From and until when given Effect

Please, try to be a detailed as possible, meaning; when, for how long and how mane tablets etc. The veterinarian’s referral letter might help.

Shampoos, ointments etc.

Name From and until when given Effect

Please, try to be a detailed as possible, meaning; when, for how long and how mane tablets etc. The veterinarian’s referral letter might help.

Shampoos, ointments etc. 2

Name From and until when given Effect

Please, try to be a detailed as possible, meaning; when, for how long and how mane tablets etc. The veterinarian’s referral letter might help.

Shampoos, ointments etc. 3

Name From and until when given Effect

Please, try to be a detailed as possible, meaning; when, for how long and how mane tablets etc. The veterinarian’s referral letter might help.

Medication administered by your veterinarian (injections etc.)

Name From and until when given Effect

Please, try to be a detailed as possible, meaning; when, for how long and how mane tablets etc. The veterinarian’s referral letter might help.

Medication administered by your veterinarian (injections etc.) 2

Name From and until when given Effect

Please, try to be a detailed as possible, meaning; when, for how long and how mane tablets etc. The veterinarian’s referral letter might help.

Medication administered by your veterinarian (injections etc.) 3

Name From and until when given Effect

Please, try to be a detailed as possible, meaning; when, for how long and how mane tablets etc. The veterinarian’s referral letter might help.