About
Evaluation
Canine Fitness Programs
Water Treadmill
Nutrition Consulting
Wellness Referrals
Contact
About
Evaluation
Canine Fitness Programs
Water Treadmill
Nutrition Consulting
Wellness Referrals
Contact
Nutrition Consultant Form
Your First Name
(Required)
Your Last Name
(Required)
Your Dog’s Name
(Required)
Dog's DOB
(Required)
MM slash DD slash YYYY
Dog's Breed
(Required)
Sex
Male
Female
Is your dog Spayed or Neutered?
(Required)
Yes
No
Unsure
Current Weight (in pounds):
(Required)
Does your dog have normal fecal eliminations?
(Required)
Yes
No
Unsure
If not, please describe:
Your current veterinarian (please list all):
(Required)
Does your dog have any current medical conditions?
(Required)
Yes
No
Unsure
If yes, please list
Does your dog have any major health history we should be aware of (surgeries, illnesses)?
(Required)
Yes
No
Unsure
If yes, please list
Does your dog have any physical limitations?
(Required)
Yes
No
Unsure
If yes, please list
Is your dog currently taking any medications?
(Required)
Yes
No
Unsure
If yes, please list
Is your dog currently taking any supplements?
(Required)
Yes
No
Unsure
If yes, please list
Does your dog have any known food allergies?
(Required)
Yes
No
Unsure
If yes, please list
Please describe your dog’s energy level:
(Required)
Weekly Activity: (Mark all that apply, please note frequency and any details you would like to include)
(Required)
Walking
Running
Swimming
Playtime
Mental workouts
Training
Sports
Other
Describe any of the above or add more:
What is your dog’s favorite activity?
Does your dog get chiropractic adjustments?
(Required)
Yes
No
If yes, with who?
Does your dog get acupunture?
(Required)
Yes
No
If yes, with who?
Please describe your dog’s appetite:
(Required)
What do you currently feed your dog? (Please list brand and type)
(Required)
What treats or toppers do you use?
(Required)
How much food does your dog get per meal?
(Required)
How often do you feed your dog?
(Required)
Are there any foods you avoid feeding?
(Required)
What best describes your goal for this consultation?
(Required)
I am interested in learning more about my dog’s current diet and what I can add to improve it
I am interested in transitioning to a fresh food diet but don’t know where to start
I am interested in learning more about fully preparing my dog’s meals and formulating balanced meal plans
I am interested in becoming better informed about how to source specific food items
Other
Anything to add?
Do you have any specific questions or subjects you would like to discuss? Please include as much detail as you like.
