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Consultation Form
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Owner Information
Name
Email
Phone
State/Country
Do you already have or use any Iv San Bernard products?
—Please choose an option—
Yes
No
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
Check all that apply:
Crusty
Oozy
Inflamed
Sores
Itchy
Odor
Hair loss
Dry/Flaky
Other
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
or
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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