info@highlandsveterinaryhospital.com.au
(02) 4872 1144
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Understanding Your Dog's Itchy Skin
Understanding Your Dog’s Itchy Skin
Different itching behaviours can indicate different conditions. Please answer a few questions to better understand your dog’s skin irritation so we can better help them find a source of comfort.
Date:
Dog's Name:
Breed:
Age:
Gender:
Your Dog’s Skin History
Which of the following itchy skin behaviours does your dog experience?:
Scratching
Rolling/rubbing
Biting/chewing
Licking
Scooting
Head shaking
Other
Other Option
How long has your dog been itchy?:
At what age did your dog first start showing signs of a skin problem?:
Does the skin problem happen::
Continuously
Intermittently
Only at home
My dog hasn’t experienced a skin problem before
At certain times of the year
Randomly/no discernible pattern
Don’t know
Only at particular places
Have you tried home remedies or other treatments? If yes, please describe. (This may include anti-itch medications, shampoos, creams, hypoallergenic food, antibiotics, antihistamines or other products):
What was the response to treatment?:
Full resolution
Partial/Temporary resolution
No effect
Is your dog currently receiving any parasite control (for fleas/ticks/mites)?:
Yes
No
If yes, please list the product(s) you are using:
How often do you administer it?:
Your Dog’s Itch Score
Please indicate how itchy your dog currently is on the scale below. 0 = no itch; 10 = extremely severe, constant itch:
1
2
3
4
5
6
7
8
9
10
Quality of Life
Itchy skin conditions can have a negative impact on your dog’s quality of life, as well as your own. This can include an impact on your or their overall comfort or sleeping patterns; your ability to enjoy activities together; or the time and difficulty in administering treatments for your dog’s skin.
Your Dog’s Quality of Life
On the scale below, please indicate how much of an impact your dog’s skin condition currently has on your dog. 0 = no impact; 10 = extreme impact:
1
2
3
4
5
6
7
8
9
10
What is most concerning you?:
Your Quality of Life
On the scale below, please indicate how much of an impact your dog’s skin condition currently has on your life, and that of other members of your household. 0 = no impact; 10 = extreme impact:
1
2
3
4
5
6
7
8
9
10
What is most concerning you?:
Your Dog’s Skin Changes
Please indicate where you notice changes in your dog’s skin that concern you. This may include places where your dog scratches, licks or bites; areas of redness or hair loss; scabs or “pimples” on the skin; or any other skin, ear or feet changes.:
Right Side
Left Side
Dorsal
Ventral
Email Address
HIGHlands Locations We Serve
Braemar
Mittagong
Colo Vale
Alpine
Aylmerton
Renwick
Welby
Bowral
Moss Vale
Hill Top
Yerrinbool
Burradoo
Berrima
Contact Details
66 Old Hume Hwy
Braemar NSW 2575, Australia
(02) 4872 1144
info@highlandsveterinaryhospital.com.au
Hours
Mon - Fri: 8:15 am to 5:00 pm
Sat: 8:15 am to 12:00 pm
Sun: Closed
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