Name First Name Last Name Your pet's name * Has your pet had any history of gastrointestinal issues in the past? Yes No When did the diarrhea start? * Less than 24 hours 1-2 days 3-7 days More than a week How frequently is your pet having diarrhea? * 1-2 times 3.-5 times 6+ times What does the diarrhea look like? (Check all that apply) * Watery Soft but formed Mucous present Undigested food particles None of the above / Unsure Have you noticed any of the following symptoms along with diarrhea? * Vomiting Lethargy or weakness Loss of appetite Increased thirst Increased urination Bloated or distended abdomen Drooling Change in behavior or hiding Weight loss Abdominal pain (whining, hunching, sensitivity when touched) None of the above Have there been any changes in your pet’s diet recently? * Yes No If yes, please describe the new food, treats, or changes: Has your pet been exposed to any of the following recently? * Contact with other animals Boarding or daycare Stressful situations (e.g., travel, new home, visitors) Recent vaccinations or medications Outdoor activities like hiking or swimming None of the above / Unsure Has your pet ingested anything unusual that could have caused diarrhea? * (Check all that apply) Table scraps or people food Table scraps or people food Foreign objects (e.g., toys, bones) New treats or chews Grass or plants Unsure / don't know Has your pet been exposed to new environments or stress (e.g., travel, new pets, recent moves)? * Yes No Unsure Has your pet ingested any foreign objects (e.g., bones, toys, garbage)? * Yes No Unsure Is your pet currently on any medications or supplements? * Yes No If yes, please list them and when they were last given: Is your pet up to date on flea, tick and heartworm prevention? * Yes No Unsure Has your pet been diagnosed with any other medical conditions (e.g., kidney disease, pancreatitis)? Yes No Unsure Is there anything else you’d like to mention regarding your pet’s health or recent changes? If your address or phone number has changed, kindly update your new contact details below. Thank you!
