Hypothyroidism Monitoring Survey Pet's Name: Client's Name Preferred Phone Number Is this a mobile number? Yes No Preferred E-mail Time Thyro-Tab was last given: Thyro-Tab dose given: Time of last meal: Is patient readily taking the Thyro-tabs? Yes No Please list all other medications and supplements Current diet (please include brand, amount, frequency):Has you pet experienced any of the following: Excessive water consumption Excessive panting Restlessness Excessive weight loss other specify Have the symptoms of hypothyroidism your pet was experiencing improved? Yes No (common symptoms include unexpected weight gain, lethargy, reduced activity, hair loss, oily/scaly skin)Please explain the improvements.Please list any questions or concerns you have about managing hypothyroidism.
