Recheck History Form

Keep your pet’s dermatology care on track by submitting our recheck form before your upcoming appointment. Your detailed answers help our team understand your pet’s progress and ensure we tailor treatment to their current needs.

Get Started

Tell Us How Your Pet Is Doing

Thank you for helping us provide exceptional follow-up care. Please complete the form below with as much detail as possible. If you have questions or need help with the form, don’t hesitate to contact our Chicago clinic.

Recheck History Form

Owner's Name *

First

Last

Email *

Phone

Pet's Name *

How are your pet's skin and ears doing currently?

Rate your pet's level of itch on a scale from 0 to 10. (0 is normal, and 10 is the worst an animal can be)

Please list out your pet's current medications, how frequently they are being given, and how much you have left:

Please make sure to include any over-the-counter supplements and topical therapies, such as ear cleaner and shampoo.

If your pet is a canine and has had a cytopoint injection before, would you like us to repeat it at this appointment?

Has your pet had any recent bloodwork done?

What diet are you currently feeding your pet?

How has your pet's appetite and water intake been?

your water 0

Is your pet experiencing any coughing, sneezing, vomiting, or diarrhea?

How has your pet's attitude and activity been?

Please list out any other concerns you may have:

Please provide the best phone number to contact you at: *

Signature *

Clear Signature

Please sign to consent for physical exam, diagnostics, and treatment.

Today's Date *

Recheck History Form

Tell Us How Your Pet Is Doing

Recheck History Form

We’re Ready to Help Your Pet Feel Better

Have a question?

Contact Information:

Address:

Hours of Operation: