Nutritional Assessment

Name: Integrative Pet Wellness Center
Address: 739 Deep Valley Drive, Rolling Hills Estates, CA, 90274, United States
Telephone: 213-316-6886
Price range: $

Nutrition is the foundation of health. This is one of the most important things for a happy and healthy pet! A proper diet can have positive effects on your pet’s health. Optimizing diet and supplementing appropriately can have a profound effect in helping your pet overcome disease states or preventing cancer and inflammatory conditions. Full nutritional assessment and supplement evaluation are offered for current patients. Please contact our team to schedule an appointment.

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Nutritional Assessment

Please fill out our Nutritional Assessment Form in its entirety to ensure we can provide you and your pet with the best possible care. Please Note: Any fields with * are required.

Pet Parent Full Name(Required)

First Last

Email(Required)

Mobile Phone(Required)

Your Pet's Name(Required)

Species(Required)

Dog

Cat

Breed(Required)

Age(Required)

Gender(Required)

Male

Female

Spayed or Neutered?(Required)

Yes

Where is your pet housed?(Required)

Indoors

Outdoors

How active is your pet?(Required)

Extremely active (sports, training, races)

Very active (exercising a lot, running, or hiking)

Average (go on walks)

Not very active (occasional walks)

Mostly inactive (sleeps most of the time)

How often is your pet walked?(Required)

At least 3 times a day

1-2 times a day

Once daily

Seldom (1-2 times a week)

Never

Do you have any other pets?(Required)

Yes

Are pets fed separately?(Required)

Yes

Does your pet have access to other, unmonitored food sources?(Required)

Yes

If yes to the above, please describe(Required)

Does your pet have a good appetite?(Required)

Yes

Yes, but picky or finicky

What is your preference for diet at home?

Mostly commercial food I can pick up

Home cooked recipes - I love cooking for my pet and I can cook from scratch

Home cooked recipes - I don't mind some cooking but prefer something easy

Other

What is your priority for this nutrition consultation (the most important part you want to make sure gets answered)?(Required)

Do you have a preference for the type of foods you feed: for example, raw food vs. fresh frozen, cooked foods vs. dehydrated or freeze-dried?(Required)

If picky or does not have good appetite, please explain or describe your experience.(Required)

Who feeds your pet?(Required)

Have you made any recent changes in diet (last 4 weeks)?(Required)

Yes

If you made recent changes, please note what the change was and why you made it:(Required)

List current diet, how much you are feeding, how often per day and how long your pet has been on this diet:(Required)

List all current treats, snacks, dental hygiene product, rawhide, and any other foods your pet is currently eating:(Required)

List all current medications and supplements (for example - herbal medications, vitamins, glucosamine, turmeric, omega fatty acids):(Required)

How do you administer medications or supplements to your pet? (for example, time of the day, mixed with food, mixed with treats, given by itself, etc)(Required)

What are your pet's food preferences? What are his/her favorite things to eat?(Required)

What foods does your pet refuse?

Are there any known foods NOT tolerated by your pet?

Please list any other commercial or homemade diets you are not currently feeding but have fed in the last 2-3 months:

Does your pet have a temperature preference?(Required)

Prefers warmth (likes to lay in the sun or in a blanket)

Prefers coolness (gets hot easily)

Neutral

I am not sure

Anything else we should know? (Any little thing you can think of!)

That's it! Thank you for being an awesome super pet parent. We are so happy to partner with you to take care of one of your pet's most important healthcare needs. ❤️