Pet Health Questionnaire

Pet's first and last name:*:

Appetite:

Normal
Increased
Decreased

Any weight loss or weight gain observed?:

Yes
No

Dry food brand & amount:

Canned food brand & amount:

Treat name and table food:

Any food concerns?:

Where do you purchase your pet's food?:

How would you describe your pet's activity level:

Non-active
Moderately active
Very active

How would you describe your pet's weight?:

Too thin
Normal weight
Gained a few pounds
Needs to lose weight

Please select the image below from 1 to 5 that best describes your pet:

How would you describe your pet's breath?:

Not bad for a dog's breath
Unpleasant
Really bad (needs mouthwash)

Current medications & supplements:

CURRENT FOOD