Coughing/Sneezing Form

Is your pet also coughing and/or wheezing while sneezing? *

Phone: *

Does your pet's behavior resemble allergies? *

Yes

No

Not sure

Does your pet sound like it is reverse sneezing? *

Yes

No

Not sure

When do you notice it the most? (AM, PM, etc.)

When did the cough start?

Has your pet recently boarded? *

Yes

No

Is there discharge in your pet's sneezes, and if so what color? *

If yes, what does the cough sound like? (deep, honking, harsh, dry, etc.)

Could your pet have gotten into anything? (household detergents, etc.) *

Have there been any changes to your pet's routine? *

Yes

No

Name: *

Has your pet been diagnosed with CHF, bronchitis, pneumonia, etc.? *

Yes

No

Is your pet sneezing? If so, how frequently? *

Has your pet been to a dog park or groomer? *

Yes

No

If yes, what medication is currently prescribed and how often is it given?

If yes, what is the time and date?

Is your pet up to date on vaccines, specifically bordetella? *

Yes

No

Not sure

Is your pet coughing? *

Is there blood coming from the nostrils? *

Yes

No

Not sure

When your pet coughs, do they gag, spit up, or vomit? *

Was your pet recently in a shelter? *

Yes

No

If any of the above, what does it look like? (white foam, mucous, bile, etc.) *

Is your pet on heartworm medication? *

Yes

No

Not sure

Does your pet have trouble breathing between coughing fits? *

Yes

No

Pet's name: *

Does your pet cough after exercise? *

Yes

No

Do you already have an appointment scheduled? *

Yes

No

Other Forms