Pet Nutrition Intake Form

For nutritional consulting and evaluations, please complete the form below.

The more accurate information that we have the better we can pinpoint the issue. Thank you!

"*" indicates required fields

Name * Required

First Last

Email * Required

Phone * Required

Which location are you closest to? * Required

Sun City

Casa Grande

List any Veterinarian(s) your pet has seen in the last year

Consent * Required

I agree to the terms and conditions.

I allow Feed Right Pet Food, Inc. to use any information I provided to evaluate the health and nutritional needs of my pet(s). I understand that no one employed at Feed Right Pet Food, Inc. are veterinarians, nor do we claim to be. Allen Smith and Cassidy Jeffers are both certified canine and feline nutritionists. They collectively have over 25 years of experience in animal health based on proper nutrition and healthy supplementation. We are not liable for any outcomes, promised or implied. We always encourage you to seek the advice of a holistic veterinarian.

Pet 1

Pet's Name * Required

Breed? * Required

Male or Female? * Required

Male

Female

Approximate weight? * Required

Approximate age? * Required

Please list all food, snacks, treats, etc. that you give to your pet. (even occasional treats) * Required

Please list any prescription food(s) you have fed? (canned/dry) and how recently.

What type of water bowl do you use? (tap water/ filtered, etc?) * Required

What type of food bowl do you use? * Required

Please list any past medications/supplements you have given. * Required

Date of most recent vaccination. Was it 1 year or 3 years? * Required

Current medications/supplements * Required

Apoquel

Previcox

Durama xx

Carprofen (Novox or Rimadyl)

Metacam

Aspirin

Benadryl

Tramadol

CBD

Phenobarbital

Potassium Bromide

Keppra

Zonisamide

Mometamaxotic

Prednisone

Metronidazole Famotidine

Diphenhydramine

Doxipin

Ketoconazole

Doxycycline

Sucralfate

Other (explain below)

Do you use any parasitic? Topical or oral?

Seresto

Frontline

Frontline Plus

Advantage

K9 Advantix

Biospot

Heartguard Plus

Trifexis

Revolution

Interceptor Plus

Simparica Trio

Sentinel

Tri-Heart Plus

Ivermectin

Any tick collar

Other (explain below)

What problems is your pet experiencing? * Required

Poop eater

Dark or smelly stools

Irregular stools

“Greasy” stool

Excessive gas

Excessive water intake Vomiting or Diarrhea

Bad Breath

Tartar buildup

Dry elbows (callouses)

Open sores or hot spots

Excessive licking or chewing of the feet

Anal gland issues (butt scooting)

Weepy/red staining eyes

Ear issues/excessive buildup/scratching

Biting at tail

Excessive shedding

Lethargy/lack of energy Joint/Mobility Issues

Hair loss

Other (explain below)

Is there any additional information you want us to know about your pet?

Are you finished with the form?

Yes

No, I have a 2nd pet

Pet 2

Pet's Name (P2) * Required

Breed? * Required

Male or Female? * Required

Male

Female

Approximate weight? * Required

Approximate age? * Required

Please list all food, snacks, treats, etc. that you give to your pet. (even occasional treats) * Required

Please list any Prescription food(s) you have fed? (canned/dry) and how recently.

What type of water bowl do you use? (tap water/ filtered, etc?) * Required

What type of food bowl do you use? * Required

Current medications/supplements * Required

Apoquel

Previcox

Durama xx

Carprofen (Novox or Rimadyl)

Metacam

Aspirin

Benadryl

Tramadol

CBD

Phenobarbital

Potassium Bromide

Keppra

Zonisamide

Mometamaxotic

Prednisone

Metronidazole Famotidine

Diphenhydramine

Doxipin

Ketoconazole

Doxycycline

Sucralfate

Other (explain below)

Do you use any parasitic? Topical or oral?

Seresto

Frontline

Frontline Plus

Advantage

K9 Advantix

Biospot

Heartguard Plus

Trifexis

Revolution

Interceptor Plus

Simparica Trio

Sentinel

Tri-Heart Plus

Ivermectin

Any tick collar

Other (explain below)

What problems is your pet experiencing? * Required

Poop eater

Dark or smelly stools

Irregular stools

“Greasy” stool

Excessive gas

Excessive water intake Vomiting or Diarrhea

Bad Breath

Tartar buildup

Dry elbows (callouses)

Open sores or hot spots

Excessive licking or chewing of the feet

Anal gland issues (butt scooting)

Weepy/red staining eyes

Ear issues/excessive buildup/scratching

Biting at tail

Excessive shedding

Lethargy/lack of energy Joint/Mobility Issues

Hair loss

Other (explain below)

Please list any past medications/supplements you have given. * Required

Date of most recent vaccination. Was it 1 year or 3 year? * Required

Is there any additional information you want us to know about your pet?

Are you finished with the form?

Yes

No, I have a 3rd pet

Pet 3

Pet's Name (P3) * Required

Breed? * Required

Male or Female? * Required

Male

Female

Approximate weight? * Required

Approximate age? * Required

Please list all food, snacks, treats, etc. that you give to your pet. (even occasional treats) * Required

Please list any Prescription food(s) you have fed? (canned/dry) and how recently.

What type of water bowl do you use? (tap water/ filtered, etc?) * Required

What type of food bowl do you use? * Required

Current medications/supplements * Required

Apoquel

Previcox

Durama xx

Carprofen (Novox or Rimadyl)

Metacam

Aspirin

Benadryl

Tramadol

CBD

Phenobarbital

Potassium Bromide

Keppra

Zonisamide

Mometamaxotic

Prednisone

Metronidazole Famotidine

Diphenhydramine

Doxipin

Ketoconazole

Doxycycline

Sucralfate

Other (explain below)

Do you use any parasitic? Topical or oral?

Seresto

Frontline

Frontline Plus

Advantage

K9 Advantix

Biospot

Heartguard Plus

Trifexis

Revolution

Interceptor Plus

Simparica Trio

Sentinel

Tri-Heart Plus

Ivermectin

Any tick collar

Other (explain below)

What problems is your pet experiencing? * Required

Poop eater

Dark or smelly stools

Irregular stools

“Greasy” stool

Excessive gas

Excessive water intake Vomiting or Diarrhea

Bad Breath

Tartar buildup

Dry elbows (callouses)

Open sores or hot spots

Excessive licking or chewing of the feet

Anal gland issues (butt scooting), Weepy/red staining eyes

Ear issues/excessive buildup/scratching

Biting at tail

Excessive shedding

Lethargy/lack of energy Joint/Mobility Issues

Hair loss

Other (explain below)

Please list any past medications/supplements you have given. * Required

Date of most recent vaccination. Was it 1 year or 3 year? * Required

Is there any additional information you want us to know about your pet?

Are you finished with the form?

Yes

(if you have more than 3 pets, please start a new form.)

Final Comments

Any Last Comments or Questions?

This field is for validation purposes and should be left unchanged.

Pet Nutrition Intake Form

Pet 1

Pet 2

Pet 3

Final Comments

Sun City

Casa Grande

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