Patient Diet History Questionnaire

Nutrition plays a paramount role in your pet’s health and quality of life. By helping us fill out the following diet history form, you can support us in determining the most appropriate nutritional solution for your pet.

Owner Name*

Phone Number*

Email Address*

Pet Name*

What is your goal for nutrition?

How active is your pet?
Very ActiveModerately ActiveNot Very Active

How do you describe your pets weight?
OverweightIdeal WeightUnderweight

Where does your pet spend most of their time?
IndoorOutdoorBoth

Current Food Intake
Please include ALL food, treats, snacks, dental hygiene products, rawhides and any other foods that your pet currently eats, including all foods used to administer medications:
:

Food	Form	Amount	Frequency	Fed since

What food measuring device is being used?

If you feed canned food, what size are the cans?

Do you give your pet any dietary supplements?*
YesNo

If yes, list:*

Do you have any concerns with your pets?

Additional Nutritional Resources

Tools For Pet Owners

Information on the Internet can be confusing and there is lots of myth and misinformation on the topic of pet Nutrition. These guides (one for cat owners and one for dog owners) provide tips on effectively and objectively using the Internet. In addition, both include a list of useful and accurate Internet resources on pet Nutrition.

Nutritional Assessment Tools used by the Healthcare Team

Body Condition Score Chart for Cats
Body Condition Score Chart for Dogs
Body Condition Score Video
Muscle condition score chart for Cats
Muscle condition score chart for Dogs
‘How to perform a Muscle Condition Exam’, by Dr Lisa Freeman

Patient Diet History Questionnaire