If your dog is having diarrhea, please answer the following questions as accurately as possible to help your veterinarian determine the cause. If you are not certain about the answer, please indicate ‘not sure'
How long has the diarrhea been present? ______ hours / days / weeks
Has the diarrhea become more severe since it started? Yes / No / Same
From the list below, circle each item that applies:
A. Degree and Frequency
• one to three bowel movements per day: diarrhea / normal
• more than four bowel movements per day: diarrhea / normal
• diarrhea is occasional (some bowel movements each day are normal)
B. Consistency
• watery
• consistency of pancake batter or cream-based soup
• consistency of a cow patty or cottage cheese
• semi-formed with the consistency of soft-serve ice cream
C. Blood
• very bloody stool: bright red / dark and tarry
• small amount of blood present: bright red / dark and tarry
• no blood
D. Color
• pale or tan to yellow
• dark brown
• black & tarry in appearance
• other:
E. Miscellaneous
• thick mucus or gel coating on the stool
• pieces of foreign materials present in the stool: __________________________
• loss of bowel control (defecates in the house)
• severe straining when having a bowel movement
Is your dog's appetite normal? Yes / Decreased / Increased / Not eating at all
What has your dog consumed during the last week? List everything that you’re aware of including dog or cat foods, treats, stuffed or flavored bones, table scraps, milk, and anything else that you have fed your pet.
Are any of the above foods new to your dog? Yes / No
Does your dog receive any medications or supplements? Yes / No If Yes, what are they and how often are they given?
Could your dog have accidentally gotten some of your medication? Yes / No
Is your dog as active as normal? Yes / No
Has your dog’s water consumption changed? Increased / Decreased / No change / Not Sure
Has your dog vomited? Yes / No If Yes, how frequently and for how long?
Does your dog have access to garbage or discarded food, either within your house or yard or outside your yard? Yes / No
Does your dog have toys it could have swallowed? Yes / No If Yes, what are they?
Do any other pets or people in the home have diarrhea as well? Yes / No
