Primary Complaint Form Name * Name First First Last Last Dog Name * Email * Primary Problem * Severity of Problem * Mild Moderate Severe Has there been a recent change in frequency or severity? * Yes No Age of Pet at Onset * If yes, describe Changes in home or pet's health when problem began * Describe the problem, beginning with most recent incident * What has been done to correct the problem? * What was the dog's response to correction? * Describe first incident List medications (and dosage) that have been tired so far and dog's reaction List any other dietary treatments, supplements or remedies and the dog's response How often does this problem occur? * CAPTCHA If you are human, leave this field blank. Submit