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Call us at 707-942-0404
Home
About
Our Veterinarians
Our Care Team
Photo Gallery
Hospital Tour
Reviews
Patient of the Month
Care to Share
Services
All Services
Wellness & Vaccinations
Allergies & Dermatology
Nutrition & Weight Management
Diagnostics
Dentistry
Surgery
Regenerative Medicine
Emergency Care
Cancer Treatment
Laser Therapy
End of Life Care
Orthopedic Surgery
TPLO
FHO
Laparotomy Procedures
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Triage Forms
Wellness Exam
ADR
Skin Issues
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Ear Infection
Resources
Request an Appointment
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Request an Appointment Button
Ear Infection Triage Form
Owner's Name:
Pet's Name:
Species:
Dog
Cat
Spayed or Neutered?
Yes
No
Age:
Best way to contact owner:
Primary Concerns
Which ear is affected?
When did you first notice the ear problem?
How often does you pet show signs of discomfort?
What signs of ear discomfort has your pet shown?
Scratching
Shaking ear
Rubbing ears against objects
Tilting head
Redness or swelling
Unpleasant odor
Discharge from ear
Crusty or scabs
Sensitivity or painful
Loss of balance
Hearing loss
What color discharge from your pet’s ear?
What consistency is the discharge?
Medical History
Has your pet had ear infections in the past? If yes, how was it treated:
Is your pet currently on any medications?
Does your pet have any known allergies?
Does your pet have a history of any of the following?
Chronic ear infections
Allergies
Skin infections
Ear mites
Diet
What type of food/brand does your pet eat?
Has there been any recent changes in your pets diet?
Activity and Hygiene
Has your pet been swimming or bathed recently?
How often do you clean your pets ears?
What cleaning product do you use for bathing and cleaning ears?
Submit
Please do not fill in this field.
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