Lehigh Valley Veterinary Dermatology

4580 Crackersport Rd
Allentown, PA 18104

(610)391-1200

lehighvetderm.com

Recheck History Form

Due to COVID-19, we are offering 'curbside' service. Please call 610-391-1200 ext 0 upon arrival. The staff will meet you outside by your car and take your pet inside for further care and examination. The doctor will call you after the exam.
Please fill out the below information to the best of your ability prior to your pet's appointment.
Name (required)
First Name (required)
Last Name (required)
Pet's Name (required)

E-Mail Address :
What is the best phone number to reach you on when you are here with your pet for the appointment? (required)

Is anyone in your household showing COVID symptoms, recently tested positive for COVID, been exposed to someone with COVID, or on Department of Health Quarantine? (required)
Yes
No
To make it easier for us to see when you arrive, please tell us the model of your car and color

How has your pet been since the previous visit? (required)

If not doing well, when did the symptoms worsen?

Where on the skin are the most affected areas?

Are there any particular areas or lesions that you want the doctor to check or any other relevant updates you would like the doctor to know about?

What is the overall level of improvement your pet has shown since starting treatment here?
Mild improvement (approximately 25% better)
Moderate improvement (approximately 25-50% better)
Significant improvement (approximately 50-75% better)
So much improvement that my pet only has minimal to no symptoms
No improvement/change in symptoms
Symptoms have gotten worse
Please rate your pet's itch level on a scale of 1 to 10 (1 = minimal, 10 = obsessive/constant)
1
2
3
4
5
6
7
8
9
10
How often are you bathing your pet?
At least twice weekly
Weekly
Every couple of weeks
As needed
Never
Only when groomed
I can't even keep up with bathing myself never mind my pet
How much allergy vaccine are you giving to your pet and how often are you giving it?

Do you notice any trends with your pet's allergy vaccine (more itchy before being due for the injection or more itchy after the injection)? If so, please describe

Are you giving your pet any antihistamines such as generic or brandname Zyrtec, Clairitin, Benadryl, other? Please include the total milligrams and how often

Please list any other medications you are currently giving your pet. Please include the total milligrams and how often

Do you need any refills of medications while you are here including allergy vaccine? Please include the desired quantity.

What is the name of your pet's primary care veterinarian and/or veterinary office?


Verify the reCAPTCHA: