Patient History – Ears Pet's First Name*Pet's Last Name*Email* Shaking head?*YesNoScratching ear(s)?*YesNoWhich ear?Left earRight earBoth earsHead tilt?*YesNoRubbing face?*YesNoIs there a foul odor?*YesNoIs there any debris visible in ear(s) affected?*YesNoDoes your pet have history of this issue?*YesNoHow long has patient been experiencing the current issue?*CommentsThis field is for validation purposes and should be left unchanged.