Please fill out as thoroughly as possible so that an Iv San Bernard consultant can best assist you in creating a skin therapy plan. For best help, please include several well-lit photos of affected areas.

    Owner / Groomer Information

    Name

    Phone

    State/Country

    Pet Information

    Pet Name

    Pet Weight:

    Gender:

    Species:

    Which other species is it?

    Breed:

    Pet’s current diet (please include any treats/supplements and if there have been any recent
    changes in diet):

    Is the pet on flea/tick medication? If so, what brand and type (oral, topical,
    etc)?

    What is the pet’s current bathing routine? (frequency and products used):

    Issue description

    Please describe issue in detail:
    How long has this been going on?

    Is this a seasonal issue?

    Check all that apply:

    Please describe odor, if applicable:

    Please list areas of hair loss, if applicable:

    Please list locations of sores, if applicable:

    Specify "other":

    Please attach full body and close-up photos of the skin (max 3 photos).

    Allow our staff to use pictures for educational purposes

    Medical Information

    Has this pet been seen by a vet for this issue?

    If yes, what, if any, was the diagnosis?

    Is the pet being actively treated by a veterinarian for this issue?

    If yes, what treatments and/or medications are currently being used?

    Has bloodwork been done recently?

    If yes, access to bloodwork results may be requested. If you have that available now, please attach
    below.

    Has the pet been seen by a specialist/Dermatologist?

    Is the pet on any medications unrelated to this issue?

    Please list medications, if applicable

    Has the pet been diagnosed with any other chronic issue, even if believed to be unrelated?

    If yes, what was the diagnosis?

    Disclaimer: This consultation form is intended for informational purposes only and does not constitute a diagnosis for your pet. Its primary purpose is to assist in formulating a plan of action based on the information provided. Please be aware that the accuracy and completeness of the details shared will directly influence the effectiveness of our recommendations. There may be situations in which we advise seeking veterinary assistance or testing for a comprehensive evaluation. It is important to note that the purpose of our recommendations is to contribute to the restoration of your pet’s skin, and our suggestions should not be considered a substitute for professional veterinary care.