Ears Form Name * First Name Last Name Pets' Name * Is your pet shaking/scratching their head? * Yes No Any redness or smell in the ears? * Yes No If yes, how long has this been an issue? History of allergies? * Yes No Does your pet swim or take frequent baths? * Yes No Current Diet? * Any GI Upset? * Yes No Please list all current medications, supplements, or herbals: (if no change from last visit, just write N/C) * Your form has been successfully submitted. Thank you!
