Thank you for your interest in a Vet Connection nutrition consultation.We would love the opportunity to work with you and your pet(s). Please allow us to get to know you and your goals for your pet’s nutrition by filling out the form below. Name * First Name Last Name Phone * (###) ### #### Email * This will enroll you in Vet Connection's email communications. Physical Address * Address 1 Address 2 City State/Province Zip/Postal Code Country My pet's name: * One pet per form, please. My pet is a: * Dog Cat Other My pet's age or date of birth: * Estimated age if exact age is unknown. My pet's breed: * My pet's color: * My pet is: * Female, spayed Female, intact Male, neutered Male, intact My pet's most recent or approximate weight: * Please describe your pet: * Ex: hyper, lazy, playful, couch potato, always happy, some aggression, behavior concerns, etc. How active is your pet? * Very Active/Working Dog (ex. >10-15 miles or >5-10 hours of exercise per week) Active (plays fetch, goes for multiple walks/week, frequently runs around the house/yard Mildly Active (may or may not get 1+ walk per week, only lightly plays on a daily basis in the house/yard Minimally Active (sleeps most of the day, gets up to eat or go to the bathroom) My goals for this consultation include: * Check any/all that apply. Weight loss Use nutrition to help manage illness or chronic disease Improve nutrition for terminal illness or near end of life To learn how to create balanced homemade recipes for my pet To know which commercial food may be ideal for my pet and my family's lifestyle Other, please elaborate below If "other" selected above, please elaborate: Please describe any current or historical issues, illnesses or chronic diseases: * If none, please type "none". Is your pet on any medication or supplements (including parasite prevention, herbs or homeopathy)? If so, please list what you give your pet, how much and how often. * If none, please type "none". What is your pet's current diet (brand/type/formula, amount per day, and any additional food/treats)? * If you currently feed a homemade diet, please provide a detailed recipe below. What diet(s) have you fed in the past? If applicable, what did you like or dislike about these particular diets? * What questions or concerns do you have for your pet's consultation? * How did you hear about Vet Connection? * If you were referred by another client, please leave their name so that we may thank them. Please provide the name of your most recent or current vet clinic: * By providing this information, consent to Vet Connection sending updated records and, if applicable, informing them of your pet's nutritional plan. Please provide any of your pet's relevant medical history: * I will email my pet's records to info@yourvetconnection.com I do not have previous medical records for my pet. Is there anything else you would like us to know about your pet or your goals for this nutrition consultation? Thank you!Please call, text or email if we have not already been in touch.I look forward to caring for your pet.—Becca830-777-6500info@yourvetconnection.com
