Cronulla Veterinary Clinic 41 The Kingsway
Cronulla, NSW, 2230
Australia
02 9527 2604

YOUR DETAILS

I am the owner (or authorised agent for) the pet mentioned below

PET DETAILS

ALLERGY QUESTIONNAIRE

Allergies in dogs are one of the most common conditions seen by veterinarians. It can be a very frustrating condition for both the pet and pet owner. But, there are many things you can try to help alleviate the symptoms.

Please complete this allergy questionnaire before the visit so that we have all the information we need to develop a customised treatment plan with you.

GENERAL INFORMATION

Pet was obtained from
Age of pet when obtained
Age of pet when allergy problem started
Frequency of symptoms
Time of day when symptoms are the worst
Location where pet spends most of its time
Areas of your property where the pet has access to

ALLERGY SYMPTOMS

Select the types of symptoms your pet displays
Please rate your pets itchiness
Areas your pet is affected

DIET HISTORY

Select the types of food your pet receives in its diet

MEDICATION HISTORY

Select the types of medications your pet has had in its lifetime
Select the medications that have helped your pet

OTHER HEALTH CONCERNS

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