• Date Format: MM slash DD slash YYYY
  • Your pet’s dietary and nutritional information is a vital part of their medical history. An accurate and thorough dietary history is needed for our medical staff to provide recommendations during times of healthy maintenance and is essential for accurately diagnosing and treating your pet in times of illness.
  • Food

  • Brand of foodDry or canned foodAmount fed, in cups or can, per feedingMeals per day?Started within the last 30 days? 
    Please list all food and treats you feed to your pet on a regular basis. For dry food, a “cup” refers to a standard 8 ounce cup. Please specify if a larger cup is used and provide the estimated volume.
  • Type of foodAmount givenHow many times per day? 
    (table scraps, vegetables, fruit etc)
  • Brand of treatHow many times per day? 
  • Medication Information

    A detailed record of your pet’s prescribed and over-the-counter medications is essential for our medical staff. Our staff will use this information to help guide any needed medical therapies to ensure that no drug interactions exist between medications that your pet may already be taking and medications that your pet may need to receive in the future.

    Please list all medications (prescribed by us or any veterinarian) and dietary supplements (ie.: glucosamine/chondroitin, Omega 3 or fish oils, vitamins, etc.)

  • Medication nameStrength (mg)Amount given (# pills, mL)Times given per day 
    (prescribed by a veterinarian)
  • Supplement nameStrength / Size (if applicable)Amount per day 
    (glucosamine/chondroitin, Omega 3 or fish oils, vitamins etc)
  • Brand nameTimes given per monthDay of month last given