"*" indicates required fields Client Name* First Last Pet's Name* Reason for Visit*Duration of problem(s)Day(s)Week(s)Month(s)Year(s)Frequency of problem(s):* Constant Intermittent Seasonal Other Skin Observations: check all that apply: Licks/chews paws Itching Skin infections Bites tail area Shakes head Hair loss Scratches sides Scratches ears Redness Rubs face/back Ear infections Crusts/sores Odor Sneezing Dandruff Oil skin Red/watery eyes Hives Current Diet How long on this diet? Has this pet ever been on a diet for skin problems? Yes No Which one? For how long? My pet also gets:* Table food/scraps Treats Rawhides Bones Flavored medications Supplements Shampoo How Often Name of Heartworm prevention Name of Flea Control Has your pet always lived in Hawaii? Yes No Where did your pet live before? When did your pet move here? Seasonal? Months/Years living here? Where did your pet stay? Indoor Outdoor Patio/Lanai Do you have other pets? Yes No If yes, what kindCurrent MedicationsCommentsThis field is for validation purposes and should be left unchanged.