Diarrhea Questionnaire

First Name

Date

Last Name

Phone

How long has the diarrhea/loose stool been present?

Is the diarrhea more severe now than a few days ago?

Consistency

Blood

Degree/Frequency

Amount

Color

Miscellaneous

Is your dog/cat’s appetite normal? If not, is he eating at all? What have you been feeding your dog/cat in the last week? Include dog or cat foods, treats, table foods, milk, and anything else that you have fed your pet.

Does your dog have access to foods other than what you feed it?

If so, what?

Has there been a diet change in the last few weeks?

If so, does that correspond with the onset of the diarrhea?

Is your dog as active as normal?

Describe any change in water consumption.

Has your pet vomited? If so, how frequently and for how long?

Does your pet go outside your house?

Does your pet go outside your yard?

Does your pet have access to garbage cans, either within your house or yard or outside your yard?

Does your pet have toys that it plays with that it could have swallowed?

Does your pet have access to sewing materials, such as thread or needles, rubber bands, or string?

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Diarrhea Questionnaire

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