Weekly Monitoring: Gastrointestinal (GI) Signs

Owner's Name(Required)

First Last

Your Pet's Name(Required)

Patient Number

Please include information on all of your pet’s GI signs for all days of the week.

NOTE: If your pet does not normally experience a particular sign, please skip that sign and move on to the next sign that your pet experiences (e.g. if you pet does not regularly have loud stomach gurgles, skip entering information for that field).

Start Date(Required)

End Date(Required)

Day 1

Appetite

Fecal Scores

Number of bowel movements

Flatulence (i.e. gas)

Stomach gurgles

Belching and/or regurgitation

Number of episodes of vomiting

Nausea (e.g. excessive lip licking, excessive drooling, inappetence)

Dietary indiscretion (e.g. eating grass/leaves/sticks, another pet’s food, garbage/compost, pieces of bone, toys, clothing, etc.)

Anal gland issues (e.g. scooting, excessive licking, straining)

Day 2

Appetite

Fecal Scores

Number of bowel movements

Flatulence (i.e. gas)

Stomach gurgles

Belching and/or regurgitation

Number of episodes of vomiting

Nausea (e.g. excessive lip licking, excessive drooling, inappetence)

Dietary indiscretion (e.g. eating grass/leaves/sticks, another pet’s food, garbage/compost, pieces of bone, toys, clothing, etc.)

Anal gland issues (e.g. scooting, excessive licking, straining)

Day 3

Appetite

Fecal Scores

Number of bowel movements

Flatulence (i.e. gas)

Stomach gurgles

Belching and/or regurgitation

Number of episodes of vomiting

Nausea (e.g. excessive lip licking, excessive drooling, inappetence)

Dietary indiscretion (e.g. eating grass/leaves/sticks, another pet’s food, garbage/compost, pieces of bone, toys, clothing, etc.)

Anal gland issues (e.g. scooting, excessive licking, straining)

Day 4

Appetite

Fecal Scores

Number of bowel movements

Flatulence (i.e. gas)

Stomach gurgles

Belching and/or regurgitation

Number of episodes of vomiting

Nausea (e.g. excessive lip licking, excessive drooling, inappetence)

Dietary indiscretion (e.g. eating grass/leaves/sticks, another pet’s food, garbage/compost, pieces of bone, toys, clothing, etc.)

Anal gland issues (e.g. scooting, excessive licking, straining)

Day 5

Appetite

Fecal Scores

Number of bowel movements

Flatulence (i.e. gas)

Stomach gurgles

Belching and/or regurgitation

Number of episodes of vomiting

Nausea (e.g. excessive lip licking, excessive drooling, inappetence)

Dietary indiscretion (e.g. eating grass/leaves/sticks, another pet’s food, garbage/compost, pieces of bone, toys, clothing, etc.)

Anal gland issues (e.g. scooting, excessive licking, straining)

Day 6

Appetite

Fecal Scores

Number of bowel movements

Flatulence (i.e. gas)

Stomach gurgles

Belching and/or regurgitation

Number of episodes of vomiting

Nausea (e.g. excessive lip licking, excessive drooling, inappetence)

Dietary indiscretion (e.g. eating grass/leaves/sticks, another pet’s food, garbage/compost, pieces of bone, toys, clothing, etc.)

Anal gland issues (e.g. scooting, excessive licking, straining)

Day 7

Appetite

Fecal Scores

Number of bowel movements

Flatulence (i.e. gas)

Stomach gurgles

Belching and/or regurgitation

Number of episodes of vomiting

Nausea (e.g. excessive lip licking, excessive drooling, inappetence)

Dietary indiscretion (e.g. eating grass/leaves/sticks, another pet’s food, garbage/compost, pieces of bone, toys, clothing, etc.)

Anal gland issues (e.g. scooting, excessive licking, straining)

Additional Information

Please describe the color of your pet’s feces

Please list any content/inclusions in your pet’s feces.

Please add any additional details about your pet’s GI signs that you feel are pertinent:

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Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Additional Information

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