1. How long has the diarrhea been present?
2. Is the diarrhea more severe now than a few days ago?
3. Circle the letter of each item that applies:
Consistency
(a) Watery stool
(b) Stool is the thickness of pancake batter
Blood
(c) Very bloody stool
(d) Only sporadic blood present
(e) Blood not present in stool
(f) Bright red blood present
(g) Dark, tarry blood present
Degree/Frequency
(h) Entire stool is soft or watery
(i) Only portions of the stool are soft or watery
(j) Diarrhea with each bowel movement
(k) Diarrhea is sporadic (some bowel movements are normal)
(l) Only 1 or 2 bowel movements per day
(m) More than 4 bowel movements per day
Amount
(n) Increased, large amount of stool
(o) Decreased or normal, small amounts of stool
Color
(p) Stool is dark brown in color
(q) Stool is very pale in color
(r) Stool is black and tarry in appearance
Miscellaneous
(s) Thick mucus or pieces of tissue present in stool
(t) Loss of bowel control (defecates in the house on the floor)
(u) Severe straining when having a bowel movement
Is your dog’s appetite normal? If not, is it eating at all?
What have you been feeding your dog during the last week? Include dog or cat foods, treats, table foods, milk, and anything else that you have fed your pet. Also state what percentage of the diet is each item or category.
Does your dog have access to foods other than what you feed it? If so, what?
Has there been a diet change in the last few weeks? If so, does that correspond with the onset of the diarrhea?
Is your dog as active as normal?
Describe any change in water consumption. (increased or decreased)
Has your pet vomited? If so, how frequently and for how long?
Does your dog go outside your house?
Does your dog go outside your yard?
Does your dog have access to garbage cans, either within your house or yard or outside your yard?
Does your dog have toys that it plays with that it could have swallowed?
Does your dog have access to sewing materials, such as thread or needles, rubber bands, or string?
Do you have other dogs or cats that live with this one? If so, does the other pet have diarrhea?
Do any of the members of your family currently have a diarrhea problem?
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