DIETARY HISTORY QUESTIONNAIRE

In addition to answering the following questions, please also submit pictures of the ingredient labels of all currently fed dry food, wet food, chews, cookies, treats etc. Alternatively, you may bring all the foods and treats offered to your pet to your first appointment.

    Does your pet get any human food (specifically cooked for pet or offered from food prepared for family members)?

    YesNo

    If YES, how often?

    If YES, please list what types of human food is offered to your pet?

    Does your pet frequently get into garbage or eat things outdoors?

    YesNo

    Does your pet spend time outdoors without your direct supervision?

    YesNo

    Have you pursued a diet elimination trial or changed any of the food or treats for your pet in order to help improve the dermatologic concerns?

    YesNo

    If YES:

    Did you observe an improvement in your pet’s itching/symptoms?

    YesNo

    Did you observe an aggravation in your pet’s itching/symptoms?

    YesNo

    Do you feel that your pet may have some type food allergy?

    YesNo

    Thank you for taking the time to provide us with feedback regarding your pet’s dietary history. If you would like to offer additional feedback, please provide it in the following space:

    Interested in information about Pet Dermatology?

    Sign up for our newsletter and receive our content directly in your email.
    Sign Up Now