GPH VETERINARY SERVICES INC. GPH VETERINARY SERVICES INC.

1st floor Tony Saweg Building Atab Junction, Balacbac 1st floor Tony Saweg Building Atab Junction, Balacbac
Santo Tomas Proper Marcos Highway Baguio City Santo Tomas Proper Marcos Highway Baguio City
SMART: 09197313655 GLOBE: 09676845821 SMART: 09197313655 GLOBE: 09676845821

SKIN & EAR PROBLEM TREATMENT PLAN SKIN & EAR PROBLEM TREATMENT PLAN
DATE ISSUED:_______________________________________ DATE ISSUED:_______________________________________

Pat. Number :________ Name of Pet:_______________________________ Pat. Number :________ Name of Pet:_______________________________
Age:_______ Sex: []M []MC []F []FS Recc Diet:____________________on______________________ Age:_______ Sex: []M []MC []F []FS Recc Diet:____________________on______________________
[]1st time case []Recurrent []1st time case []Recurrent

Name of Owner:_______________________________________________ Name of Owner:_______________________________________________

TEST DONE: TEST DONE:

SKIN SCRAPE: + / - []Sarcoptic []Demodex []Other spp_________________EAR SWAB + / - EAR MITES SKIN SCRAPE: + / - []Sarcoptic []Demodex []Other spp_________________EAR SWAB + / - EAR MITES
WOODSLAMP/UV TEST + / - FUNGAL CULTURE + / - [] CBC Other Tests: WOODSLAMP/UV TEST + / - FUNGAL CULTURE + / - [] CBC Other Tests:

RETEST ON:__________________________________ON:___________________________________________ RETEST:_____________________________________ON:___________________________________________

TREATMENT FOR GALIS/ EAR MITE SCHEDULES: TREATMENT FOR GALIS/ EAR MITE SCHEDULES:
1ST / + 1ST / +
2ND / + 2ND / +
3RD / + 3RD / +
4TH / + 4TH / +
5TH / + 5TH / +
6TH / + 6TH / +
/ /

MEDICATED EAR FLUSH/ BATH SCHEDULES: MEDICATED EAR FLUSH/ BATH SCHEDULES:
1ST + 1ST +
2ND + 2ND +
3RD + 3RD +
TH TH
4 + 4 +

MEDICAL EXAM & LABORATORY TEST is recommended before treatment. MEDICAL EXAM & LABORATORY TEST is recommended before treatment.
PRICE RATES: PRICE RATES:
Medical Exam:350php INJECTION FOR GALIS: []250 []350 []450 Medical Exam:350php INJECTION FOR GALIS: []250 []350 []450
Skin Scrape: 250 php MEDICATED EAR FLUSH: []250 []350 []450 Skin Scrape: 250 php MEDICATED EAR FLUSH: []250 []350 []450
Ear Swab: 250 php MEDICATED BATH: []450 []550 []750 Ear Swab: 250 php MEDICATED BATH: []450 []550 []750
CBC: 750 NEXGARD: []450 []550 []650 []750 CBC: 750 NEXGARD: []450 []550 []650 []750
BROADLINE: []450 []550 BROADLINE: []450 []550
Rx PRESCRIBED FOR FOR ANIMAL USE ONLY: Rx PRESCRIBED FOR FOR ANIMAL USE ONLY:

1. # 1. #
Sig: Sig:

2. # 2. #
Sig: Sig:

3. # 3. #
Sig: Sig:

4. # 4. #
Sig: Sig:

5. # 5. #
Sig: Sig:

NOTES: NOTES:
FOOD:________________________________ FOOD:________________________________
AVOID CHICKEN & BEEF BASED HUMAN FOOD AVOID CHICKEN & BEEF BASED HUMAN FOOD
ALL MEDICATIONS AFTER MEALS ALL MEDICATIONS AFTER MEALS
SHAMPOO:___________________________ SHAMPOO:___________________________
* Not directly applied (Diluted with water 1st) * Not directly applied (Diluted with water 1st)
ATTENDING VETERINARIAN ATTENDING VETERINARIAN
GPH VETERINARY SERVICES INC. GPH VETERINARY SERVICES INC.