Diarrhea Questionnaire and Checklist for Dogs
Diarrhea is sign of disease, rather than a specific diagnosis. In order for your veterinary healthcare team to narrow down the cause of diarrhea in your dog, please answer the following questions as accurately as possible. If you are not certain about the answer, please indicate ‘approximately’ or ’not sure’.
1) How long has the diarrhea been present? ___________ hours / days / weeks
Use a calendar or try to relate it to significant events or occasions, such as holidays. Note any other changes in your dog’s routine or the routine in the household.
2) Has the diarrhea become more severe now than a few days ago? More severe / Less severe / Same
3) From the list below, circle each item that applies:
A. Degree and Frequency
- entire bowel movement is soft or watery
- stool starts out formed and becomes runny at the end
- only portions of the stool are soft or watery
- diarrhea is present with each bowel movement
- only 1 or 2 bowel movements per day - diarrhea or normal
- more than 4 bowel movements per day - diarrhea or normal
- diarrhea is occasional (some bowel movements each day are normal)
- first bowel movement of the day is normal
- first bowel movement of the day is diarrhea
- last bowel movement of the day is normal
- last bowel movement of the day is diarrhea
B. Consistency (see illustration below)
- watery stool
- stool is the thickness of pancake batter or cream-based soup (is very runny and spreads out)
- stool has the consistency of a cow patty or cottage cheese
- stool is semi-formed and has the consistency of soft-serve ice cream (has a shape but loses form when picked up)
- very bloody stool
- only occasional, small amount of fresh blood present
- blood not present in stool
- bright red blood present
- dark, tarry appearance
D. Amount of Feces or Diarrhea
- large amount of stool produced with each bowel movement
- more frequent bowel movements with normal volume each time
- increase in both frequency and volume
Decreased or normal amounts of stool
- stool is dark brown in color
- stool is very pale or tan to yellow in color
- stool is black and tarry in appearance
- thick mucus or gel coating on the stool
- pieces of tissue present in the stool
- stool is extremely smelly
- loss of bowel control (defecates in the house on the floor)
- severe straining when having a bowel movement
4) Is your dog's appetite normal? Yes / No If not, is he eating at all? Yes / No
5) What have you been feeding your dog during the last week? Include dog or cat foods, treats, table foods, milk, and anything else that you have fed your pet. Also state approximately what percentage of the diet is each item or category.
6) Are any of the above foods new to your pet? Yes / No
7) Have you just opened a new bag or case of your dog's regular food? Yes / No
8) Does your dog have access to foods other than what you feed it? Yes / No If so, what?
9) Does your dog receive any medications or supplements? If so, what are they and how often does your dog receive them?
10) Could your dog have accidentally gotten some of your medication? Yes / No
11) Has there been a change in your dog's diet in the last few weeks? Yes / No If so, how soon after the change did the diarrhea occur? _________________________________
12) Is your dog as active as normal or does he appear more tired or lethargic? Yes / No
13) Describe any change in water consumption: Increased / Decreased / No change
14) Has your dog vomited? Yes / No If so, how frequently and for how long?
15) Does your dog go outside your house unattended? Yes / No
16) Does your dog go outside your yard unattended? Yes / No
17) Does your dog have access to garbage cans or discarded food, either within your house or yard or outside your yard? Yes / No
18) Does your dog have toys that it plays with that he could have swallowed? If so, what?
19) Does your dog have access to sewing materials, such as thread or needles, or rubber bands, or string? Yes / No
20) Do you have other dogs or cats that live in the same environment? Yes / No If so, do any of the other pet(s) have diarrhea or illness? Yes / No
21) Do any of the members of your family currently have a diarrhea problem? Yes / No
This client information sheet is based on material written by:
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