Anthony Animal Clinic

Canine VetSurvey©

For Use with Veterinary Doctors (Dogs)
Restricted to Professional Use


Patient's Name Weight Age
Owner's Name
E-Mail
Owner's Phone



INSTRUCTIONS:    Use "1" for mild symptoms (seldom occurs), use "2" for moderate symptoms (occurs regularly), and use "3" for severe symptoms (you are aware of it almost constantly).

Group One

 1Dry mouth-eyes-nose  6Vomits easily w/ excitement 11 Isolates away from family or other pets
 2 Keyed up, fails to calm  7 Tends toward unexplained aggression 12 Cannot adapt easily to changes in home routine
 3 Nervous  8 Fear biter 13 Afraid of thunderstorms, fireworks, etc.
 4 Unable to relax, startles easily  9 Paws sweat readily         
 5 Excessive compulsive behavior 10 High anxiety         

Group Two

 1 Joint stiffness after arising  6 Constipation, diarrhea, alternating 11 Not interested in much of anything
 2 Eyes or nose watery  7 Slow starter, slow mover         
 3 Always seems hungry  8 Circulation poor, sensitive to cold         
 4 Not interested in food  9 Subject to respiratory infection         
 5 Couch potato-like attitude 10 Sleeps more than used to         

Group Three

 
A
    7 Change in appearance of eyes 13 Overweight
 1 Trembles, episodes of weakness  8 Weight loss 14 Cannot lose weight with diet
 2 Seizures  9 Behavioral changes 15 Appetite varies
 3 Disoriented  
B
   16 Eats dirt
 4 Increased water consumption 10 Increased sleeping 17 Passes a lot of gas
 5 Urinating frequently and large amount 11 Decreased activity level         
 6 Hungry often 12 Can't get comfortable        

Group Four

 1 Exercise intolerance  5 Shortness of breath or difficult  9 Disoriented
 2 Reduced play time  6 Swelling in rear legs 10Difficulty breathing
 3 Fainting, collapse  7 Abdominal enlargement       
 4 Cough, especially at rest  8 Circulation poor, sensitive to cold       

Group Five

 
A
    
B
   21Rubs at face
 1 Taking medications over long time 11Increased shedding 22Red ventrum
 2 Frequent anesthetics, multiple surgeries 12Squinting eyes 23General itchiness
 3 Appears bloated 13Ocular discharge 24Gas
 4 Recent onset allergies 14Red eyes 25Sporadic vomit/diarrhea
 5Seizures, tremors 15Swollen puffy eyes       
 6 Change in appetite and/or weight 16Itching eyes       
 7 Stands with back arched 17Red ears       
 8 Change in water consumption 18Rubbing at ears       
 9 Lethargic, depressed, restless 19Scooting       
10Sporadic vomit/diarrhea 20Licks or chews at feet or anus       

Group Six

 1 Vomits after fatty meal  5 Recurrent diarrhea  9 Poor coat
 2 Tends to be overweight  6 Intermittent vomiting 10Stomach distress common
 3 Middle-aged female  7 Pale-colored stool       
 4 Halitosis  8 Rancid odor to stool       

Group Seven

 
A
  15Mental dullness  
D
  
 1Hyperactive 16Depression 30Excessive water consumption
 2 Weight loss 17Exercise intolerant 31Increased urination
 3Increased skin temperature 18 Back problems 32 Abnormal urination behavior
 4 Racing heart 19 Weak pulse 33 Thin skin
 
B
   20Stiff gait 34 Panting all the time
 5 Increased shedding 21 Constipation 35 Respiratory distress
 6 Thinning or sparse coat 22 Dry eyes, change in eyes 36 Lethargic
 7 Bald spots 23Weak knee ligaments 37Change in behavior
 8 Dry, scaly skin  
C
   38 Pacing
 9 Oily, greasy coat 24 Failing memory 39 Muscles weak
10 Increased pigment to skin 25 Abnormal thirst 40 Distended abdomen
11 Thickened fold around face 26 Weight gain around rear end 41 Weak knees
12Cold intolerant 27Neutered male retains sexual activity 42 Isolates away from family or other pets
13 Increased weight 28 Abnormal heat cycles of intact females  
 
  
14Lethargic 29 Intact female; no heat cycle  
 
 

 
E
  
43Weakness
44 Depression
45Slow heart
46Intermittent anorexia
47 Intermittent vomiting and diarrhea
48 Weak pulse
49 Collapse

Group Eight

 1 Halitosis  5 Rubs at face  9 Cries with movement to head
 2 Difficulty eating dry food  6 Chews to one side 10 Swelling to face
 3 Drooling  7 Drops food       
 4 Bleeding from mouth or nose  8 Picky eater       

Group Nine

 1 Rubs at ears  4 Shakes head  7 Greasy/oily skin
 2 Odor to ears  5 Body odor  8 Odor that returns shortly after bath
 3 Gooey ears  6 Moist under front/rear legs       

Group Ten

 
A
   6Body odor 11Fur falls out
 1 Increased shedding  7 Skin crawls 12 Dull coat
 2 Itching  8 Poor fur quality 13 Rarely itches
 3 Red bumps to skin  9 Areas of changed skin appearance 14Excessive shedding
 4Scabs or crusts to skin 10Sores on skin 15 Smooth skin at bald areas
 5Dandruff  
B
  16 No scratching noticed