Valley Fever (coccidioidomycosis) Animal Survey
By valleyfeversurvivor.comTM

This survey is to be taken by pet owners whose animals have been infected with Valley Fever.

If you feel this survey does not apply to you, then click here to return to the Home Page.
Otherwise, please fill out the survey below. Your input really does matter.

Your Name:     Male   Female

Email:     Age:

Home Town/State:

Phone:    

Animal's Name:    Male   Female

Type of Animal:    

Animal's current age:     Animal's age when diagnosed:
  

1)   Town and state where your animal contracted VF
  
2)   Was your pet on any medication?    Yes    No
  
3)   If yes, what was it and how long was it taken?
  
4)   Does he or she still need medication? Yes    No
  
5)   Were there any side effects to the drugs? Yes    No
  
6)   If yes, what were the side effects?
  
7)   Please indicate the symptoms of your pet's illness by checking the boxes below that apply:
Cough Weight loss Lack of appetite
Fever Depression Malaise
Wheezing Lameness Sudden seizures
Swollen joints Change in personality Skin absecces
  
8)   If known, what was your pet's titer?
  
9)   Were you aware that your pet could contract Valley Fever before his or her illness? Yes    No
  
10)   What is your pet's prognosis?
  
11)   What is the name of your veterenarian and where is he or she located?
  
12)   What was your out-of-pocket cost for treating your pet's Valley Fever infection?
$
  
13)   Please select the description that applies to your pet's Valley Fever illness
My pet fully recovered
My pet still has/had some VF-related problems
My pet died because of Valley Fever
I had to put my pet down because he or she was too sick.
I had to put my pet down because I could not afford the medication
  
14)   Please describe your pet's life before and after his/her valley fever infection

Thank you for filling out our survey.


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