IDT Intake Form Owner and Pet Information LAST NAME * FIRST NAME * PET'S NAME * WHAT MEDICATIONS IS YOUR PET CURRENTLY RECEIVING? * INCLUDE INJECTABLE, ORAL, TOPICAL AND EAR/EYE MEDICATIONS HAS YOUR PET RECEIVED ANY ORAL STEROIDS IN THE LAST 4 WEEKS? * YES NO HAS YOUR PET RECEIVED ANY TOPICAL STEROIDS OR ANTIHISTAMINES IN THE LAST 2 WEEKS? * YES NO WOULD YOU PREFER TO DO INJECTABLE OR ORAL IMMUNOTHERAPY? * Select one INJECTABLE ORAL ARE THERE ANY MEDICATIONS OR FOODS THAT YOU NEED REFILLED? DO YOU HAVE ANY CONCERNS ABOUT HOW YOUR PET IS DOING THAT YOU WISH TO DISCUSS WITH THE DOCTOR? --PLEASE NOTE THAT A RECHECK EXAM FEE WOULD APPLY-- FASTING INSTRUCTIONS * I ACKNOWLEDGE THAT I SHOULD FAST MY PET PRIOR TO THE APPOINTMENT (NO FOOD 6 HOURS PRIOR, WATER IS OKAY TO GIVE) Thank you! Your submission has been received.
