Ophthalmic History FormWant to email it to us instead? Download a PDF hereName(Required) First Last Email(Required) How old was your pet when it was acquired and where was your pet acquired?(Required)Is your pet currently vaccinated?(Required) Yes NoAre there other pets in the household?(Required) Yes NoWhat are they?(Required)Are your pets indoor and/or outdoor?(Required) Indoor OutdoorDoes your pet travel out of Oregon?(Required) Yes NoWhen did your pet’s eye problem begin?(Required)What symptoms have you observed at home?(Required) Squinting? Rubbing? Tearing/discharge? Decreased vision? Redness?What procedures/treatments have been performed by your veterinarian?(Required)Please list all the medications that your pet has received in the past 3 months: (Drugs, dosage and how frequently given)(Required)Please list any other medical problems and duration of these conditions:CAPTCHAΔ