Dermatology Questionnaire

Please fill out this form before your appointment.

Appointment Telemedicine

3

Date *

Owner Name *

First

Last

Email *

Horse's Name *

Age when purchased? *

What 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, intermittent, or seasonal? *

Continual
Intermittent
Seasonal

Does the horse itch? *

Yes
No

Do any horses in contact with the affected horse have skin problems? *

Yes
No
No other horses come in contact

Do any people in contact with the horse have skin problems? *

Yes
No

Do you use insect control? *

Yes
No

List any insect control products utilized on the horse now or in the past. *

Do any relatives of this horse have skin problems? *

Yes
No

Please list any injectable, oral, or topical medications that have been used to treat the problem (veterinary or "home remedies"). *

Did any help the condition? *

Yes
No

Did any aggravate the condition? *

Yes
No

Describe the environment where the horse is kept (indoors, outdoors, etc.). *

Does your horse travel? *

Yes
No

What is the horse fed now, and what has the horse been fed in the past? *

Do you use any feed additives? *

Yes
No

What is your deworming schedule? *

Did the horse receive Ivermectin? *

Yes
No

List any other medical problems or drugs that the horse received. *

List any additional information you feel is relevant to the skin disease. *

Message

Expert equine care in Brandon, FL.

From our board-certified horse surgeons and board-certified internists to our professional and courteous staff, at Brandon Equine Medical Center, we are committed to the health and well-being of all breeds and sizes of horses. In the field, as an outpatient, or when admitted to the horse hospital, we treat every horse like our own and every client as the most important.

Ready to come see us?

Request your next appointment online in minutes from any device. We look forward to seeing you soon!

REQUEST NOW

Dermatology Questionnaire

Expert equine care in Brandon, FL.

Contact Info

Hours

Location

Have a question?

Ready to come see us?