QUESTIONNAIRE ANIMAL

Fill out the online questionnaire at your leisure and make sure that all information is correct.

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1 IDENT-NR.
2 QUESTIONS


NOTE: Use your order number, starting with MC.

ANIMAL INFORMATION

ANIMAL:
SEX:
PREGNANT:

Please mark only applicable

1. rarely 2. moderately 3. regularly

ANGABEN
0123
Breeding
Release person
Castrated
FUTTER
0123
Wet feed
Dried fodder
Fruit, vegetables
Herbs

Please mark only complaints by severity

1. light/rare 2. medium/moderately 3. strongly/regular

DYSBALANCE
0123
Abscesses
Aggressive
Aortic thrombosis
Claws
Constipation
Diarrhoea
Disinterested
Ears
eyes
Fearful
Flatulence
Fur
Gums
Heart
Hyperactive
Irritable colon
kidneys
Liver
Locomotor system
Lyme disease
Metabolism
Poisoning
Psychological behaviour patterns
Seizures
Skin
teeth
Worms
Medication intake
YESNO
Mao inhibitor
Painkillers
Cortisone
Closed Substance Cycle Materials
Neuroleptics
Hormones
Antibiotics
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