Diet History Form

About You and Your Pet

Select a surgery

Title

First Name

Surname

Contact Phone Number at Time of Appointment

Email Address

Is your pet a member of our Pet Health Club?

Yes
No

Date form completed

Today

Your pet's sex

Is Your Pet Neutered?

Yes
No

Please Tick Appropriate Answer

How Active is your Pet?

Very ActiveModerately ActiveNot Very Active

How would you describe your pet's weight?

OverweightIdeal WeightUnderweight

Where does your pet spend most of their time?

IndoorsOutdoorsIndoors and Outdoors

Please list below the brands and products (if applicable) and the amount of ALL foods, treats, snacks, dental hygiene products, rawhides and any other foods (including human ones!) that your pet currently eats, including foods used to administer medications:

If you feed by volume, what size measuring device do you use? If you feed tinned/canned food, what size tins/cans/trays/pouches?

Do you give any dietary supplements to your pet (E.G. Vitamins, Glucosamine, Essential Fatty Acids, or any other Supplements)?

Yes
No

If yes, please list brands and amounts per day

Before you go… Did you know that members of our Pet Health Club receive 25% off selected food brands, both life-stage and prescription diets? Additionally, PHC members receive 10% off dietary supplements. And those aren’t the only benefits. Annual vaccinations, year-round flea and worming treatment, as well as a host of other savings are also included! All for an affordable monthly payment. Check out our Offers page for further information.

Thank you for completing this form. Your responses shall be attached to your pet’s clinical records, and a clinical member of staff will review these with you during your pet’s next appointment.

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Diet History Form

Please answer the following questions about your pet, if requested to do so by Congleton Vets. This shall enable us to better understand your pet’s nutritional needs, and allow us to help you make changes that will have a positive impact on their health and lifespan.

About You and Your Pet

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Please answer the following questions about your pet, if requested to do so by Congleton Vets.
This shall enable us to better understand your pet’s nutritional needs, and allow us to help you make changes that will have a positive impact on their health and lifespan.