Your Details

Name*

e-mail address*

Postal address

My Animal is

a dog a cat

Cat/Dog Details

Name:

Breed:

Age:

Sex:

Male Female

Neutered Entire

Diet:

Symptoms and Treatments of your dog or cat

Respiratory Assessment

Nasal Discharges if any?

eg: Colour , consistency etc.

Breathing:

eg: Normal, laboured, wheeziness ? Presence of coughing ?
Is cough dry or productive ?

Digestive System Assessment

Appetite

Normal, increased, decreased.

Faces/Stools

Normal, or diarrorea, any blood present?

Urinary System Assessment

eg: Is the frequency of urination normal, increased or decreased?

Is the dog/cat drinking more than normal?

Locomotor Assessment

Gait

Stiffness Lameness Normal

If stiffness or lameness is present, is it more apparent after exercise or what time of day does it occur?
Is movement free or restricted?

Skin and Coat Assessment

Condition of coat

Oily Shiny dry dull

Condition of Skin

Normal flaky dry dandruff present

Is there any odour off skin? Yes No

Scratching

Is the animal scratching? Yes No

If so what time of day does it occur, how bad is the scratching and what part of the animal's body is affected? Describe the distribution of lesions if there are any present, if there is hair loss and where this loss is. Is the skin inflamed, red or broken?

General Assessment

Ears

normal held up drooping

Nose

Hot Cold

Breath

Normal bad odour

Eyes

Clear Discharge
Nature of discharge if present

Teeth

Condition of teeth

Behaviour

Brave Timid Easily frightened Temperamental
Other

Sleeping pattern

Does the animal dream? While lying does the dog or cat lie on a mat or an uncovered floor? Does the animal lie close to or away from fire/heat?

If you have any further comments on your cat or dog please enter them here and we will try to reply to your enquiry as soon as possible