Whole Pet Evaluation and Consultation

Today's Date:

Owner's Details

Email:

Phone:

Pet's Details

Pet's Name:

Species of Pet:

Breed of Pet:

Pet's Age:

Sex:

MaleFemale

Desexed?:

YesNo

Type of work (guard, farm, couch potato, etc.:

Health complaints (list and describe with length of time):

Describe hair:

Body Score (1 = very thin, 5 = very fat):

Describe Diet:

List drugs, medications, and supplements currently taking:

List traumas, surgeries, major illness with dates and outcomes:

General emotional state and pack status:

Living conditions: What percentage of time does your pet spend in the house and outside?:

Below rate your dog’s current condition from 0-3 (0 = not an issue, 1 = very mild or slight, 2 = moderate or occasional, 3 = severe)

Digestive upset: