Skip to Main Content Skip to Footer

CAREERS | Online Pharmacy

Hours 6945 Hwy 72 W
Huntsville, AL 35806

About Us
Services
Contact
Pet Corner

Request an Appointment

Request an Appointment
Call: (256) 489-8387
Hours
About Us
Services
Contact
Pet Corner
Online Pharmacy
Careers

Check Ears Intake Form

When did first symptom start?

Have you noticed any of the following? Check all that apply.

Shaking of the head

Scratching at one or both ears

Odor from ear(s)

Discharge/Debris from ear(s)

Warmth to the touch Redness Swelling

On a level 1-10, 1 being hardly noticeable and 10 being no rest at all, what would you rate the patient comfort level?

Does the patient have a history of ear infection?

Has the patient had a recent groom or bath?

Yes

No

Does the patient have a history of food or environmental allergies?

What is the patient normal diet? What is the protein source?

Is the patient on any heartworm, flea, or tick prevention? If so, what and when was last dose given?

Is the patient on any routine medication? If so, please list name, dosage, and frequency of use.

Does the patient have any issues with medication that we need to be aware of?

Has the patient ever been to a dermatologist?

Yes

No

Unsure

Has the patient ever been treated with alternative therapies that we should be aware of?

Is the patient up to date on vaccines ( If patient is new to our practice)

Yes

No

Unsure

Does the patient have pet insurance? If yes, what plan?

Any other concerns you would like to address with the doctor today?

pet ear concerns

Trusty Vet

6945 Hwy 72 W Huntsville, AL 35806 email: Hello@trustyvet.com phone: (256) 489-8387

We are closed for lunch daily from 12PM-1PM.

Office Hours

Monday: 7:00am - 6:00pm

Tuesday: 7:00am - 6:00pm

Wednesday: 7:00am - 6:00pm

Thursday: 7:00am - 6:00pm

Friday: 7:00am - 6:00pm

Saturday: Closed

Sunday: Closed

View our holiday hours and closings >

careers Pet Portal

© 2024 Trusty Vet. All rights reserved.
Privacy Policy | Terms & Conditions

Modal title

Cras mattis consectetur purus sit amet fermentum. Cras justo odio, dapibus ac facilisis in, egestas eget quam. Morbi leo risus, porta ac consectetur ac, vestibulum at eros.

Google Recaptcha