EAR INFECTION

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Ear Infection Questionaire

Please tell us about your pet's medical issue.

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Name *

First

Last

Pet *

Best contact number to reach you if we have any questions. *

Please confirm the best email to send any information pertaining to your pet. *

Which ear(s)? *

RIGHT LEFT BOTH

How Long? *

Has your pet had a recent diet change or new treats/food introduced? *

Yes No Not Sure

SUMMER-Does Your Pet Swim? *

Yes No

WINTER-Does your pet rub their ears in the snow? *

Yes No

What brand of diet and type (canned/dry/both) is your pet currently eating and if it has changed, what was their previous diet. Please list any treats your pet receives. *

Are there any other areas of your pet's body that are affected (common areas are anal glands, armpits, the groin area and feet)? *

Collecting samples from your pet's ears is very necessary to determine what is causing the infection (bacteria, yeast or both) and looking at them under the microscope. This helps determine the best treatment for your pet. Do we have your permission to swab your pet's ears? *

Yes No

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