Dermatology QuestionnaireOwner Name*Date Date Format: MM slash DD slash YYYY Horse's nameAge when purchasedWhat is the horse's use?What is your complaint about the horse's skin?Age of horse?Age when skin problem started?Where on the body did the problem start?What did the skin problem look like initially?How has it spread or changed?Is the problem continual or intermittent?If seasonal, what season(s) is the disease present?Does the horse itch?YesNoIf so, where?Do any horses in contact with the affected horse have skin problems?If so, are they similar or different from this horse's problem?Do any people in contact with the horse have skin problems ?Do you use insect control?YesNoIf yes, describeList any insect control products utilized on the horse now or in the pastDo any relatives of this horse have skin problems?YesNoIf yes, explainPlease list any injectable, oral, or topical medications that have been used to treat the problem (veterinary or "home remedies")Did any help the condition?YesNoIf yes, which ones?Did any aggravate the condition?YesNoIf yes, which ones?Describe the environment where the horse is keptIndoorsOutdoorsDoes your horse travel?YesNoIf yes, where and when?What is the horse fed now and what has the horse been fed in the past?What feed additives do you use?What is your deworming schedule?Did the horse receive Ivermectin?YesNoList any other medical problems or drugs that the horse receivedList any additional information you feel is relevant to the skin diseasCAPTCHANameThis field is for validation purposes and should be left unchanged.
