Consultation Form - experienceklos.com

Owner Information

Name

Phone

State/Country

Do you already have or use any Iv San Bernard products?

Pet Information

Pet Name

Pet Weight:

Pet Age

Gender

Intact Male Intact Female Spayed Female Neutered Male

Species

Dog

Breed:

Pet’s current diet (please include any treats/supplements and if there have been any recent changes in diet):

Is the pet on flea/tick medication? If so, what brand and type (oral, topical, etc)?

What is the pet’s current bathing routine? (frequency and products used):

Issue description

Please describe issue in detail:

How long has this been going on?

Is this a seasonal issue?

Yes No

Please describe odor, if applicable:

Please list areas of hair loss, if applicable:

Please list locations of sores, if applicable:

Specify "other":

Please attach full body and close-up photos of the skin (max 3 photos).

Drag & Drop Files Here

Browse Files

Allow our staff to use pictures for educational purposes

Yes No

Medical Information

Has this pet been seen by a vet for this issue?

Yes No

If yes, what, if any, was the diagnosis?

Is the pet being actively treated by a veterinarian for this issue?

Yes No

If yes, what treatments and/or medications are currently being used?

Has bloodwork been done recently?

Yes No

If yes, access to bloodwork results may be requested. If you have that available now, please attach below.

Has the pet been seen by a specialist/Dermatologist?

Yes No

Is the pet on any medications unrelated to this issue?

Yes No

Please list medications, if applicable

Has the pet been diagnosed with any other chronic issue, even if believed to be unrelated?

Yes No

If yes, what was the diagnosis?

Disclaimer: This consultation form is intended for informational purposes only and does not constitute a diagnosis for your pet. Its primary purpose is to assist in formulating a plan of action based on the information provided. Please be aware that the accuracy and completeness of the details shared will directly influence the effectiveness of our recommendations. There may be situations in which we advise seeking veterinary assistance or testing for a comprehensive evaluation. It is important to note that the purpose of our recommendations is to contribute to the restoration of your pet’s skin, and our suggestions should not be considered a substitute for professional veterinary care.

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Owner Information

Pet Information

Issue description

Medical Information

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Owner Information

Pet Information

Issue description

Medical Information

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