Please fill out this form as accurately as possible if you would like to
discuss weight loss at your appointment, or if you’ve been asked to by a CVH employee.
Email * Pet's Name * Breed or Color * Age: * Species (dog, cat, etc) * Previous medical conditions requiring hospitalization Name of Pet Food * Amount Fed Per Day * Are you satisfied with this food in general: How long as your pet been on this diet: * Describe Daily Treats/Table Food: include flavor, brand, size. Be as thorough as possible. Describe Weekly Treats/Table Food : include flavor, brand, size. Be as thorough as possible. If you use dental chews, please indicate how often, the brand, the flavor: Do you use anything additional in order to give daily or weekly medications? * Do you use dental chews? * Does your pet get treats, food toys, or puzzles for training, entertainment or distraction? If so, describe food contents as thoroughly as possible: Is your pet on any supplements: list brand, flavor here. Be as specific as possible. Is your pet on any flavored medications/heartworm/flea & tick prevention: list here, be as specific as possible Do you care for your pet’s teeth with any flavored item: If you had to pick which body shape most closely matches your pet’s, which number would you choose? Please upload images and numbers from a body condition score chart – such as with the WSAVA