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Dermatology questionnaire cat
Stap
1
van
6
16%
Name owner
(Vereist)
Cat’s name
(Vereist)
date of birth
(Vereist)
DD slash MM slash JJJJ
Breed
(Vereist)
When is your appointment (date and time)?
Questions about the nature of the complaints
What complaints does your cat show?
(Vereist)
make your choice
skinproblems/itchiness
earproblems
both skinproblems as well as (occasional) earproblems
Since when has your cat been showing these problems/complaints?
(Vereist)
How old was your cat when these problems began?
(Vereist)
Has your cat ever been abroad?
(Vereist)
make your choice
no
yes, on holiday
yes, the cat is from abroad
Which countries has your cat been to?
(Vereist)
Does your cat show any signs of itchiness?
(Vereist)
make your choice
no
yes, minor itchiness
yes, severe itchiness
indicate where on the body the itching occurs
Do you have the impression that your cat mainly suffers from itchiness and that he/she causes the skinproblem/leasions by scratching/licking, or that there was a skinproblem in the first place that causes the itchiness?
(Vereist)
make your choice
the cat is itchy and damages the skin by scratching/licking
the cat has an underlying skinproblem which causes scratching/licking
I don’t know
General health/physical condition:
Does your cat drink more than usual?
(Vereist)
make your choice
no
yes
yes, since an injection against itchiness (prednisone)
Have your cat’s eating habits changed?
(Vereist)
make your choice
no
yes; he/she eats less than usual
yes; he/she eats more than usual
Does your cat vomit sometimes?
(Vereist)
make your choice
no
no, but has in the past
yes, occasionally
yes often
Does your cat have diarrhea sometimes?
(Vereist)
make your choice
no
no, but has in the past
yes, occasionally
yes often
Does your cat have other physical problems/complaints besides skin- and/or earproblems?
(Vereist)
make your choice
no
yes
yes my cat has other physical problems
(Vereist)
does your cat take medication for these complaints/problems?
(Vereist)
make your choice
no
yes
What medicines are used?
(Vereist)
Do you have other pets?
(Vereist)
make your choice
no
yes
Our other pets are:
(Vereist)
Does/do your other pet(s) also have skinproblems and/or itchiness?
(Vereist)
make your choice
no
yes
Do you, or other persons who come in contact with the cat, have skinproblems which started around the same time?
(Vereist)
make your choice
no
yes
Does your cat go outside?
(Vereist)
make your choice
no
yes, but only on terrace/balcony
yes, on a regular basis; suburban area/city/country side
Do you treat your cat (and other pets) with anti-flea products?
(Vereist)
make your choice
no
yes, when I notice fleas
yes, but only during summer
yes, regularly throughout the year
Which product(s) do you use?
(Vereist)
Questions regarding your cat’s diet
Did your cat follow a special diet for his/her skinproblems?
(Vereist)
Maak keuze
no
yes, of a particular brand
yes; home cooked diet
Which diet food did you use? Note brand and type
(Vereist)
This self-cooked diet, this consisted of?
(Vereist)
Did you give anything else during this diet? (snacks, treats, fruit, sweets etc.)
(Vereist)
Maak keuze
no
yes
We gave extras like:
(Vereist)
How long has your cat been on this diet?
(Vereist)
Did the skinproblems improve?
(Vereist)
Questions regarding medication your cat has been given to treat skin- and/or earproblems. Please, try to be a detailed as possible, meaning; when, for how long and how many tablets etc. The veterinarian’s referral letter might help. Which medication at home has been administered to treat the skin 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 2
Name
From and until when given
Effect
Shampoos, ointments 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
https://medicijnen-online.nl/
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