Intestinal Issues Form Name * First Name Last Name Pet's Name * Is your pet straining to defecate? * Yes No Please describe the stool. If Diarrhea Present: How long has the diarrhea been present? If Diarrhea Present: Has the diarrhea become more severe? Is your pet having difficulties producing stools? * Yes No When was the last normal stool your pet had? * Is your pet's appetite normal? * Yes No Any changes to the routine diet or treats? * Yes No If yes, please describe. Any changes in your pet's routine or new stresses at home? * Yes No If yes, please describe. 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!