Dermatologie Questionnaire Ear DOG - Medisch Centrum Voor Dieren

Dermatology questionnaire ear dog

Stap 1 van 4

Name owner(Vereist)

Dog's name(Vereist)

date of birth(Vereist)

Breed(Vereist)

When is your appointment (date and time)?

Which medication has been administered to treat the ears related problems and what was the effect. Please, try to be as detailed as possible, meaning when, for how long and how many tablet’s, ointments etc. The veterinarian’s referral letter might be of help. Which medication at home has been administered to treat the ear related problems and what was the effect.

Medication 1

Name From and until when given Effect

Medication 2

Name From and until when given Effect

Medication 3

Name From and until when given Effect

Shampoos, ointments etc.

Name From and until when given Effect

Shampoos, ointments etc. 2

Name From and until when given Effect

Shampoos, ointments etc. 3

Name From and until when given Effect

Medication administered by your veterinarian (injections etc.)

Name From and until when given Effect

Medication administered by your veterinarian (injections etc.) 2

Name From and until when given Effect

Medication administered by your veterinarian (injections etc.) 3

Name From and until when given Effect

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