Jackson Veterinary Cardiology Consultants Questionnaire

    Date or Birth: MaleFemale YesNo NormalIncreasedDecreased NormalIncreasedDecreased NormalIncreasedDecreased NormalIncreasedDecreased NormalIncreasedDecreased NormalIncreasedDecreased NoneDailyWeeklyIntermittent NoneDailyWeeklyIntermittent NoneDailyWeeklyIntermittent NoneDailyWeeklyIntermittent Start Date of Cough: WorsenedImprovedStayed the Same At nightIn the morningAfter activity/ExcitementAfter DrinkingAnytime HarshHonkingWheezingSoftWetEnds with gag YesNo YesNo NoneDailyWeeklyIntermittent With ExcitementActivity/exerciseRest/SleepAfter coughOther YesNo NoneDailyWeeklyIntermittent Dates of Events: ExcitementActivity/exerciseRest/SleepAfter coughOtherNone LimpStiffTrembling/ShakingPaddlingGum chewingUnconsciousConsciousUrinatedDefecatedNone CannedDryBothNone YesNo Every monthMost monthsRarely