Diarrhea Questionnaire
- How long has the diarrhea been present?
- Is the diarrhea more severe now than a few days ago?
- Circle the letter of each item that applies:
Consistency
- Watery stool
- Stool is the thickness of pancake batter
- Very bloody stool
- Only sporadic blood present
- Blood not present in stool
- Bright red blood present
- Dark, tarry blood present
- Entire stool is soft or watery
- Only portions of the stool are soft or watery
- Diarrhea with each bowel movement
- Diarrhea is sporadic (some bowel movements are normal)
- Only 1 or 2 bowel movements per day
- More than 4 bowel movements per day
- Stool is dark brown in color
- Stool is very pale in color
- Stool is black and tarry in appearance
- Thick mucus or pieces of tissue present in stool
- Loss of bowel control (defecates in the house on the floor)
- Severe straining when having a bowel movement
Is your dog's appetite normal? If not, is it eating at all?
What have you been feeding your dog during the last week? (Include dog or cat foods, treats, table foods, milk, and anything else that it gets on a daily basis. Also state what percentage of the diet is each item or category.)
Does your dog have access to foods other than what you feed it? If so, what?
Has there been a significant diet change in the last few weeks? If so, does that correspond with the onset of the diarrhea?
Is your dog as active as normal?
Describe any change in water consumption (up or down).
Has vomiting been occurring? If so, how frequently and for how long?
Does your dog go outside your house?
