Click here to login to NorthStar VETS Referring Doctor portal.     Make a Payment Online     Ask A Vet
GET DIRECTIONS
609.259.8300
315 Robbinsville-Allentown Rd., Robbinsville, NJ 08691
2834 Route 73N, Maple Shade, NJ 08052
507 Route 70, Brick, NJ 08723

Dermatology and Allergy Service Questionnaire







Robbinsville     Maple Shade




Dog    Cat   



Female   Male   


Yes    No   


Scratching, chewing, licking, rubbing skin
Ear infections
Hair Loss with itching
Hair Loss without itching
Red Bumps, pimples,scabs
Excessive dandruff, scaling
Skin odor, greasiness
Nail infections or nail loss
Other:


Yes    No   


Please specify days/weeks/months/years


Gradual    Sudden   



Yes    No   



Ears
Face
Neck
Armpits
Rump/tail area
Underside
Groin/inner thighs
Legs/Paws
Anal/genital area
Other:


Yes    No   


Yes    No   


Intermittent    Continual   


Yes    No   


Spring
Summer
Fall
Winter


Yes    No    Does Not Apply   


Yes    No


Yes    No


Yes    No   


Yes    No   


Yes    No   


Antibiotics



Yes    No   



Yes    No   




Yes    No   





Yes    No   


    Yes    No   



Yes    No   



Yes    No   


Yes    No   


Yes    No   


Yes    No


Yes    No