Questionnaire – Part II – Basset Fauve De Bretagne Club

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2020/21 Questionnaire: PART II - Skin Conditions

Title (optional)

Name (optional)

First

Last

Email (optional)

Address (optional)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Pet Name of Fauve (optional)

Kennel Club (KC) Registered Name of Fauve (optional)

Current Age of Fauve *

Age of Fauve When Condition First Noticed *

Dog or Bitch? *

Dog
Bitch

Is your Fauve Neutered? *

Yes
No

Has your Fauve Been Used for Breeding? *

Yes
No

Does your Fauve have annual vaccinations (e.g. Leptospirosis / Kennel Cough)? *

Yes
No

Please indicate each skin condition or symptoms your Fauve suffers from *

Hair Loss
Foul Odour
Inflammation/Redness
Itching/Scratching
Otitis/Ear Infections
Licking/Chewing
Skin Sores/Lesions
Skin Changes (colour/texture)
Other

If "other" selected, please provide more information:

Please indicate for each skin condition or symptom selected its severity on a scale of 1 least severe to 10 most severe (e.g. Hair Loss 3 & Licking/Chewing 4) *

Condition Diagnosed by Vet? *

Yes
No

If condition diagnosed by Vet, please provide more details:

Does your Fauve also suffer with other illness in addition to the skin condition(s)? *

Yes
No

If "yes", please provide more information:

Is the skin condition permanent or intermittent (e.g. seasonal)? *

Permanent
Intermittent

During which seasons or months does the condition occur or worsen (if at all)? *

If your Fauve suffers itching/scratching, does this occur gradually or is it triggered suddenly? *

Gradual
Sudden
Not Applicable

If your Fauve suffers skin sores/lesions, do they occur before any itching/scratching or after any itching/scratching or do they occur simultaneously? *

Before
After
Simultaneous
Not Applicable

Has your Fauve suffered any behavioural changes? *

Yes
No

If "yes", please provide more information:

Is your Fauve on a flea/tick preventative treatment? *

Yes
No

If "yes", please confirm product & frequency of treatment

Is your Fauve on a worming preventative treatment? *

Yes
No

If "yes", please confirm product & frequency of treatment

Please indicate the type of food most regularly fed to your Fauve *

Dry/Kibble
Wet/Tinned
Raw
Other

If "other" selected, please provide more information:

Please confirm food brand & type (if applicable) - e.g. Arden Grange Lamb & Rice kibble *

Please outline any changes made to your Fauve's diet because of the skin condition(s) including any supplements you provide to your Fauve (if applicable) *

As a result of the skin condition(s), how do you rate your Fauve's quality of life? *

Excellent
Good
Fair
Poor
Very Poor