Animal Allergy & Dermatology Center of Indiana, LLC.
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Client history form

    Client History Form


    Why are we seeing your pet?
    IBD? Seizures? Other?
    breeder? pet store? rescue organization?

    Permission to Photograph

    I grant to Animal Allergy & Dermatology Center of Indiana, LLC (AADCI), the exclusive right to take photographs of my pet(s).  I authorize AADCI, it's assignees, and transferees, to copyright, use and publish the same in print and/or electronically.

    I agree that AADCI may use such photographs of my pet with or without my name for any lawful purpose, including such purposes as teaching, publications, illustration, advertising, and internet content.

    Examples of such use:  AADCI Facebook posts, website photo gallergy, in lectures given to other veterinarians, students, and interns.



    For the following symptoms, please check which symptoms have been present and how severe they have been over the entire course of the pet's skin or ear problem(s).  Please check only ONE box for each symptom.
    ​

     For each body area, please choose whether your pet is not itchy, mildly itchy, moderately itchy, or severely itchy?

    It is important that we know which types of medications have been given to your pet in the past, and whether or not they were helpful in providing relief.  For the list of medications below, please check whether or not your pet has received these medications previously.

Submit

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  • Home
  • Prescription Refills
  • Meet the Team!
  • Client Forms
  • Online Pharmacy
  • Referring Veterinarians
  • rDVM Consultation Request
  • Contact
  • Client Resources