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Skin Allergy Questionnaire

Fill this out before your visit so your vet can see the full picture.

Painting of a scruffy terrier scratching its ear beside a checklist clipboard

This questionnaire helps us prepare for your visit. It does not replace an exam and is not for emergencies. If your pet is in distress, contact your nearest emergency veterinary hospital.

Species
Age when signs started
Under 1 year
1 to 7 years
Over 7 years
Not sure
Red paws or paw licking

Red paws or paw licking

Ear itching or ear infections

Ear itching or ear infections

Face rubbing

Face rubbing

Belly or armpit redness

Belly or armpit redness

Rear-end or tail-base itching

Rear-end or tail-base itching

Hot spot

Hot spot

Skin infections that keep coming back

Skin infections that keep coming back

Soft stool or frequent bowel movements

Soft stool or frequent bowel movements

Pattern
Seasonal
Year-round
Comes and goes
Itch level (1 = none, 10 = constant)
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